Transcranial ultrasonography to detect intracranial pathology: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Transcranial ultrasonography (TCU) can be a useful diagnostic tool in evaluating intracranial pathology in patients with limited or delayed access to routine neuroimaging in critical care or austere settings. We reviewed available literature investigating the diagnostic utility of TCU for detecting pediatric and adult patient's intracranial pathology in patients with intact skulls and reported diagnostic accuracy measures. METHODS: We performed a systematic review of PubMed® , Cochrane Library, Embase® , Scopus® , Web of Science™, and Cumulative Index to Nursing and Allied Health Literature databases to identify articles evaluating ultrasound-based detection of intracranial pathology in comparison to routine imaging using broad Medical Subject Heading sets. Two independent reviewers reviewed the retrieved articles for bias using the Quality Assessment of Diagnostic Accuracy Studies tools and extracted measures of diagnostic accuracy and ultrasound parameters. Data were pooled using meta-analysis implementing a random-effects approach to examine the sensitivity, specificity, and accuracy of ultrasound-based diagnosis. RESULTS: A total of 44 studies out of the 3432 articles screened met the eligibility criteria, totaling 2426 patients (Mean age: 60.1 ± 14.52 years). We found tumors, intracranial hemorrhage (ICH), and neurodegenerative diseases in the eligible studies. Sensitivity, specificity, and accuracy of TCU and their 95% confidence intervals were 0.80 (0.72, 0.89), 0.71 (0.59, 0.82), and 0.76 (0.71, 0.82) for neurodegenerative diseases; 0.88 (0.74, 1.02), 0.81 (0.50, 1.12), and 0.94 (0.92, 0.96) for ICH; and 0.97 (0.92, 1.03), 0.99 (0.96, 1.01), and 0.99 (0.97, 1.01) for intracranial masses. No studies reported ultrasound presets. CONCLUSIONS: TCU has a reasonable sensitivity and specificity for detecting intracranial pathology involving ICH and tumors with clinical applications in remote locations or where standard imaging is unavailable. Future studies should investigate ultrasound parameters to enhance diagnostic accuracy in diagnosing intracranial pathology.

Brain topography on adult ultrasound images: Techniques, interpretation, and image library.

BACKGROUND AND PURPOSE: Many studies have explored the possibility of using cranial ultrasound for discerning intracranial pathologies like tumors, hemorrhagic stroke, or subdural hemorrhage in clinical scenarios where computer tomography may not be accessible or feasible. The visualization of intracranial anatomy on B-mode ultrasound is challenging due to the presence of the skull that limits insonation to a few segments on the temporal bone that are thin enough to allow transcranial transmission of sound. Several artifacts are produced by hyperechoic signals inherent in brain and skull anatomy when images are created using temporal windows. METHODS: While the literature has investigated the accuracy of diagnosis of intracranial pathology with ultrasound, we lack a reference source for images acquired on cranial topography on B-mode ultrasound to illustrate the appearance of normal and abnormal structures of the brain and skull. Two investigators underwent hands-on training in Cranial point-of-care ultrasound (c-POCUS) and acquired multiple images from each patient to obtain the most in-depth images of brain to investigate all visible anatomical structures and pathology within 24 hours of any CT/MRI imaging done. RESULTS: Most reproducible structures visible on c-POCUS included bony parts and parenchymal structures. Transcranial and abdominal presets were equivalent in elucidating anatomical structures. Brain pathology like parenchymal hemorrhage, cerebral edema, and hydrocephalus were also visualized. CONCLUSIONS: We present an illustrated anatomical atlas of cranial ultrasound B-mode images acquired in various pathologies in a critical care environment and compare our findings with published literature by performing a scoping review of literature on the subject.

Repeat prescribing safety survey.

INTRODUCTION Repeat prescribing is an accepted part of general practice activities in New Zealand and in many developed countries. However, there has been little research on how this service is used in New Zealand, or on clinicians' attitudes towards it. AIM To discover the opinions of vocationally registered general practitioners (GPs) and general practice registrars regarding repeat prescribing, availability of practice policy and mechanisms for issuing such prescriptions. METHODS A survey was developed by an expert group and shared through the Royal New Zealand College of General Practitioners' (the College) weekly newsletter, epulse, inviting members to participate in the survey. The survey was also emailed to registrars. RESULTS In total, 144 vocationally registered GPs and 115 registrars responded (n=259), giving a response rate of 3.2% for GPs and 12.7% for registrars. Patient convenience and time efficiency for the practice were the most commonly cited reasons for repeat prescribing. Registrars had low awareness of practice policy on repeat prescribing and only one-quarter of practices had an orientation pack that contained advice on repeat prescribing. DISCUSSION Better practice systems are likely to improve the safety profile of repeat prescribing and should be addressed. There is substantial unwanted variability currently in these practice systems.

Caption-based topical descriptors for microscopic images as published in academic papers.

BACKGROUND: Visual findings summarized in the figures and tables of academic papers are invaluable sources for biomedical researchers. Captions associated with the visual findings are often neglected while retrieving biomedical images in published academic papers. OBJECTIVES: This study is to assess caption-based topical descriptors for microscopic images of breast neoplasms, as published in academic papers retrieved through the PubMed Central database. METHOD: Human indexers as well as an automatic keyword finder called TAPoR generated the topical descriptors from collected captions. The study then compared the human-generated descriptors to machine-generated descriptors. Finally, a set of core descriptors was developed from both sets and automatically mapped into the Unified Medical Language System's (UMLS) Metathesaurus through a MetaMap Transfer engine. RESULTS: Major topical descriptors included histologic disease names, laboratory procedures, genetic functions and components. Human indexers provided more relevant descriptors than TAPoR. The UMLS Metathesaurus identified several semantic types including Indicator, Reagent, or Diagnostic Aid; Organic Chemical; Laboratory Procedure; Spatial Concept; Qualitative Concept; and Quantitative Concept. DISCUSSION: The findings suggest that caption-based descriptors can complement title or abstract-based literature indexing for figure image retrieval in articles. With respect to forming a metadata framework for online microscopic image description, the semantic types can be used as a core metadata set. In this regard, this finding can be used for standardising a microscopic image description protocol to train medical students. CONCLUSIONS: It is incumbent upon libraries and other information agencies to promote and maintain an interest in the opportunities and challenges associated with biomedical imaging.