Is Dental Panoramic Radiography Reliable to Assess Position of Bicortical Fixation Screws in Mandibular Fractures? Case Report

Background: Panoramic radiography is widely used as a diagnostic tool before oral surgeries and can be considered the foremost follow-up image after. It provides a broad observation of the maxillomandibular complex at a lower cost and radiation dose. But cone-beam computed tomography (CBCT) examination, after panoramic radiograph evaluation, can produce a change in the diagnostic thinking of maxillofacial surgeons leading to alterations in treatment plans. Objective: We aim to report a case with incidentally discovered radiographic findings where diagnostic changes were caused by switching from panoramic to CBCT imaging. Conclusion: Radiographic assessment of the position and angulation of screws by panoramic x-ray should be approached with extreme caution. The image of choice is CBCT if nerve injury is suspected.

Research, Clinical, and Sociological Aspects of Autism

The concept of autism continues to evolve. Not only have the central diagnostic criteria that define autism evolved but understanding of the label and how autism is viewed in research, clinical and sociological terms has also changed. Several key issues have emerged in relation to research, clinical and sociological aspects of autism. Shifts in research focus to encompass the massive heterogeneity covered under the label and appreciation that autism rarely exists in a diagnostic vacuum have brought about new questions and challenges. Diagnostic changes, increasing moves towards early diagnosis and intervention, and a greater appreciation of autism in girls and women and into adulthood and old age have similarly impacted on autism in the clinic. Discussions about autism in socio-political terms have also increased, as exemplified by the rise of ideas such as neurodiversity and an increasingly vocal dialogue with those diagnosed on the autism spectrum. Such changes are to be welcomed, but at the same time bring with them new challenges. Those changes also offer an insight into what might be further to come for the label of autism.

Importance of the Second Opinion in Surgical Breast Pathology and Its Therapeutic Implications

Introduction/Objective Histopathological diagnosis determines surgical management and complementary therapies in patients with breast cancer. There has been reported significant diagnostic divergences, between 7.8 and 26%, and in tumor markers between 3.4 and 41%. We evaluate the agreement between diagnoses of general pathologists and specialists of our center, in which serious discrepancies could have therapeutic repercussions. Methods Method: A retrospective study from 2012 to 2019. The cases were classified in benign and malignant. The atypical lesions were included with benign. Major disagreements were considered when there was a change in diagnosis from benign to malignant or vice versa, variation from intraepithelial to microinvasive carcinomas, infiltrating to intraductal carcinomas or vice versa. When necessary, we repeat routine stains and/or immunostains, or add new immunostains. Material: 295 cases. 294 women and 1 man. 228 biopsies and 67 immunostains of prognostic-predictive factors. Results We found diagnostic differences in 46/295 cases (15.6%). Major discrepancies in 32 cases (10.8%). In morphological diagnoses 11/228 (4.8%) and in immunodeterminations 20/67 (29.9%). In diagnostic changes, they highlighted 3 cases of ductal carcinoma in situ (DCIS) to benign, 2 cases of benign lesions to DCIS, 1 benign to invasive ductal carcinoma (IDC), 1 DCIS to IDC and 1 IDC to DCIS. Conclusion We found serious diagnostic divergences in 32 of 295 cases, 10.8%, which could have varied the therapeutic approach. In morphological interpretation 4.8% and in immunohistochemical results 29.9%. This should motivate multidisciplinary teams to routinely use the second opinion in surgical breast disease

Comparing the magnitude of improvement for patients with and without personality disorders in open-ended psychotherapy

Psychotherapy tends to produce meaningful and sustained positive changes for individuals suffering from a mental illness. A salient distinction can be made between patients with a Personality Disorder (PD) and those without. There is some evidence that patients with PD have poorer treatment outcomes, but the majority of these studies are from time-limited interventions that might be less suited for patients with PD. In contrast, the present study provided open-ended psychotherapy to a sample of patients (N = 370), half of which had at least one PD before treatment. The therapists received instruction to organize their treatments in cooperation with patients so that therapy was tailored to each patient’s individual needs and characteristics. The results revealed that patients with a PD demonstrated equal symptomatic improvement and greater interpersonal improvement compared to patients without a PD. Similarly, observer-rated diagnostic changes were equivalent across the two groups. Both groups demonstrated enduring improvements when assessed at a two-and-half-year follow-up. The degree of personality pathology was positively related to the magnitude of change, i.e. patients with more severe personality problems demonstrated greater gains in the open-ended treatment format.

Improving Resident Feedback on Diagnostic Reasoning after Handovers: The LOOP Project

Appropriate calibration of clinical reasoning is critical to becoming a competent physician. Lack of follow-up after transitions of care can present a barrier to calibration. This study aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners’ self-efficacy. Trainees shared feedback via a structured form within their electronic health record’s secure messaging system. Forms were analyzed for diagnostic changes. Surveys evaluated comfort with sharing feedback, self-efficacy in identifying and mitigating cognitive biases’ negative effects, and perceived educational value of night admissions—all of which improved after implementation. Analysis of 544 forms revealed a 43.7% diagnostic change rate spanning the transition from night-shift to day-shift providers; of the changes made, 29% (12.7% of cases overall) were major changes. This study suggests that structured feedback on clinical reasoning for overnight admissions is a promising approach to improve residents’ diagnostic calibration, particularly given how often diagnostic changes occur.

Temporal trends in incidence of childhood cancer in Switzerland, 1985-2014

STRUCTURED ABSTRACTBackgroundIncidence of childhood cancer increased in most countries worldwide, but the reasons are unclear. This study investigates trends in childhood cancer incidence in Switzerland from 1985 to 2014.MethodsWe extracted data on all childhood cancer cases diagnosed at ages 0-14 years in Switzerland from the Swiss Childhood Cancer Registry. We included ICCC-3 main groups I-XII and calculated age-standardised, cumulative, and age-specific incidence for different diagnostic groups. We analysed trends in annual age-standardised incidence using JoinPoint regression models.ResultsOver the study period from 1985-2014, 5104 of 5486 cancer diagnoses (93%) were microscopically verified. The proportion of children treated in paediatric cancer centres increased from 84% during 1985-1994 to 93% in 1995-2004 and 98% in 2005-2014 (p<0.001). Using the 2010 European standard population, age-standardised incidence was 143 in 1985-1994, 154 in 1995-2004, and 162 per million in 2005-2014. Over the period 1985-2014, incidence for all cancers increased by 0.7% (95% confidence interval [CI] 0.5-1.0) per year, 0.8% (95% CI 0.2%-1.4%) for leukaemias, 3.8% (95% CI 1.7%-6.0%) for epithelial neoplasms and melanomas, and 3.0% (95% CI 1.3%-4.6%) for CNS tumours for the period 1985-2002.ConclusionTrends in incidence were driven mostly by increases among leukaemias and CNS tumours. For CNS tumours, observed trends may be explained at least partially by diagnostic changes and improved registration. For leukaemias, rising incidence may be real and at least partly due to changes in risk factors.HighlightsIn Switzerland, incidence of childhood cancer increased by 18% from 1985-2014.Increase in incidence was mainly caused by brain tumours and leukaemias.Improved registration and diagnostics may have increased brain tumour incidence.Increasing trend for leukaemias may be real, but reasons remain elusive.

Diagnostic accuracy of imaging brain vesicular monoamine transporter type 2 (VMAT2) in clinically uncertain parkinsonian syndrome (CUPS): a 3-year follow-up study in community patients

ObjectivesTo further validate the diagnostic utility of 18F-AV-133 vesicular monoamine transporter type 2 (VMAT2) positron emission tomography (PET) in patients with clinically uncertain parkinsonian syndromes (CUPS) by comparison to clinical diagnosis at 3 years follow-up.Design, setting and participantsIn a previous study, we reported that 18F-AV-133 PET in community patients with CUPS changed diagnosis and management and increased diagnostic confidence. The current diagnosis of this cohort was obtained from the patient and treating specialist and compared with the diagnosis suggested 3 years earlier by the 18F-AV-133 PET. A second 18F-AV-133 PET was available in those with a discordant or inconclusive final diagnosis.Study outcome measuresThe primary end point was the proportion of patients who had a follow-up clinical diagnosis, which was concordant with their initial 18F-AV-133 PET scan. Secondary end points were the proportion of patients who had the same diagnosis at follow-up as that reached after the initial scan and the stability of diagnostic changes made after the first scan.Results81 of the 85 patients previously recruited to the CUPS study had follow-up of which 79 had a clinical diagnosis and 2 remained CUPS. The diagnosis was in agreement with the initial 18F-AV-133 PET scan result in 74 cases. Five patients had a discordant diagnosis; one patient with rubral tremor had a severely abnormal scan that had worsened when rescanned; four cases with normal initial and repeat scans had a clinical diagnosis of Parkinson’s disease. Two patients with suspected genetic disorders remained classified as CUPS and both had normal scans. In the 24 CUPS cohort patients where 18F-AV-133 PET initially changed diagnosis, this change was supported by follow-up diagnosis in all but the one rubral tremor case.Conclusion18F-AV-133 PET is a useful tool in improving diagnostic accuracy in CUPS providing results and diagnostic changes that remain robust after 3 years follow-up.