A stepwise approach towards diagnostic workup in dementia using online cognitive tools

Objective: The 2020 Global Vascular Guidelines aim at improving decision making in Chronic Limb-Threatening Ischemia (CLTI) by providing a framework for evidence-based revascularization. Herein, the Global Limb Anatomic Staging System (GLASS) serves to estimate the chance of success and patency of arterial pathway revascularization based on the extent and distribution of the atherosclerotic lesions. We report the preliminary feasibility results and observer variability of the GLASS. GLASS is a part of the new global guideline and posed as a promising additional tool for EBR strategies to predict the success of lower extremity arterial revascularization. This study reports on the consistency of GLASS scoring to maximize inter-observer agreement and facilitate its application. Methods: GLASS separately scores the femoropopliteal (FP) and infrapopliteal (IP) segment based on stenosis severity, lesion length and the extent of calcification within the target artery pathway (TAP). In our stepwise approach, we used two angiographic datasets. Each following step was based on the lessons learned from the previous step. The primary outcome was inter-observer agreement measured as Cohen’s Kappa, scored by two (step 1 + 2) and four (step 3) blinded and experienced observers, respectively. Steps 1 (n = 139) and 2 (n = 50) were executed within a dataset of a Dutch interventional RCT in CLTI. Step 3 (n = 100) was performed in randomly selected all-comer CLTI patients from two vascular centers in the United States. Results: In step 1, kappa values were 0.346 (FP) and 0.180 (IP). In step 2, applied in the same dataset, the use of other experienced observers and a provided TAP, resulted in similar low kappa values 0.406 (FP) and 0.089 (IP). Subsequently, in step 3, the formation of an altered stepwise approach using component scoring, such as separate scoring of calcification and adding a ruler to the images resulted in kappa values increasing to 0.796 (FP) and 0.730 (IP). Conclusion: This retrospective GLASS validation study revealed low inter-observer agreement for unconditioned scoring. A stepwise component scoring provides acceptable agreement and a solid base for further prospective validation studies to investigate how GLASS relates to treatment outcomes.

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Adult-onset sporadic chorea: real-world data from a single-centre retrospective study

Neurological Sciences ◽

10.1007/s10072-021-05332-w ◽

2021 ◽

Author(s):

Roberta Bovenzi ◽

Matteo Conti ◽

Rocco Cerroni ◽

Mariangela Pierantozzi ◽

Alessandro Stefani ◽

...

Keyword(s):

Clinical Examination ◽

Real World ◽

Laboratory Tests ◽

Clinical Course ◽

Diagnostic Workup ◽

Adult Onset ◽

Real World Data ◽

Term Outcome ◽

Long Term Outcome ◽

World Data

Abstract Background Adult-onset sporadic chorea includes a wide and heterogeneous group of conditions whose differential diagnosis and treatments are often challenging and extensive. Objectives To analyse retrospectively cases of adult-onset sporadic chorea from a single Italian centre to provide insights for a practical approach in the management of these patients. Methods A total of 11,071 medical charts from a 9-year period (2012–2020) were reviewed, identifying 28 patients with adult-onset sporadic chorea (genetic forms excluded). All available data regarding phenomenology, diagnostic workup, aetiology, treatments, and long-term outcome from this cohort were collected and analysed. Results Adult-onset sporadic chorea occurred more frequently in females and presented with an acute-subacute onset. Cerebrovascular diseases accounted for 68% of aetiology; further causes were structural brain lesions, internal diseases, and other movement disorder syndromes. Clinical course was mild, with spontaneous resolution or minimal disturbances in 82% of cases. Neuroimaging was fundamental to diagnose 76% of adult-onset sporadic chorea, an appropriate clinical examination contributed to the 14% of diagnoses, whereas basic laboratory tests to the 10%. Conclusions Revision of real-world data of adult-onset sporadic chorea patients from a single Italian cohort suggests that an accurate clinical examination, neuroimaging, and routine laboratory tests are useful to identify those cases underlying potentially severe but treatable conditions. Although in the majority of cases adult-onset sporadic chorea has mild clinical course and good response to symptomatic treatments, it is essential to run a fast diagnostic workup.

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Cervical cancer prevention among older women – challenges in screening, diagnostic workup, and treatment

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/aogs.14162 ◽

2021 ◽

Author(s):

Line Winther Gustafson ◽

Lone Kjeld Petersen ◽

Pinar Bor ◽

Berit Andersen ◽

Anne Hammer

Keyword(s):

Cervical Cancer ◽

Cancer Prevention ◽

Older Women ◽

Cervical Cancer Prevention ◽

Diagnostic Workup

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Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

Surgical Endoscopy ◽

10.1007/s00464-021-08350-z ◽

2021 ◽

Author(s):

Eric M. Haas ◽

Thais Reif de Paula ◽

Roberto Luna-Saracho ◽

Melissa Sara Smith ◽

Jean-Paul J. LeFave

Keyword(s):

Complicated Diverticulitis ◽

Intracorporeal Anastomosis ◽

Natural Orifice ◽

Abdominal Incision ◽

Stepwise Approach ◽

Stapling Device ◽

Video Recordings ◽

Conversion Rates ◽

Technical Modifications ◽

Instrument Control

Abstract Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

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Legal Concepts as Mental Representations

International Journal for the Semiotics of Law - Revue internationale de Sémiotique juridique ◽

10.1007/s11196-021-09853-7 ◽

2021 ◽

Author(s):

Marek Jakubiec

Keyword(s):

Cognitive Science ◽

Mental Representations ◽

Legal Philosophy ◽

Current Debate ◽

Cognitive Tools ◽

Cognitive Sciences ◽

Cognitive Aspect ◽

Fundamental Level ◽

Legal Concepts ◽

Mental Constructs

AbstractAlthough much ink has been spilled on different aspects of legal concepts, the approach based on the developments of cognitive science is a still neglected area of study. The “mental” and cognitive aspect of these concepts, i.e., their features as mental constructs and cognitive tools, especially in the light of the developments of the cognitive sciences, is discussed quite rarely. The argument made by this paper is that legal concepts are best understood as mental representations. The piece explains what mental representations are and why this view matters. The explanation of legal concepts, understood as mental representations is one of (at least) three levels of explanation within legal philosophy, but—as will be argued—it is the most fundamental level. This paper analyzes the consequences of such understanding of concepts used in the field of legal philosophy. Special emphasis is put on the current debate on the analogical or amodal nature of concepts.

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