Perfusion Scotoma: A Potential Core Underestimation in CT Perfusion in the Delayed Time Window in Patients with Acute Ischemic Stroke

With the growing rise in utilization of CT perfusion for selecting patients for thrombectomy in acute ischemic stroke from large vessel occlusion, some potential pitfalls are becoming more commonly seen particularly when it comes to estimating the core infarct size on CT perfusion. Ghost infarct core has been described to account for overestimating core infarct size in the early time period (<3 hours). Herein, we describe the phenomenon of underestimating core infarct size on CT perfusion in the later time period (>6 hours), which we have termed perfusion scotoma.

The rise of affectivism

Research over the past decades has demonstrated the explanatory power of emotions, feelings, motivations, moods, and other affective processes when trying to understand and predict how we think and behave. In this consensus article, we ask: has the increasingly recognized impact of affective phenomena ushered in a new era, the era of affectivism?

Can illness beliefs, from the common-sense model, prospectively predict adherence to self-management behaviours? A systematic review and meta-analysis

OBJECTIVE

To determine whether people's beliefs about their illness, conceptualised by the common sense model (CSM), can prospectively predict adherence to self-management behaviours (including, attendance, medication, diet and exercise) in adults with acute and chronic physical illnesses.

DESIGN AND MAIN OUTCOME MEASURES

Electronic databases were searched in September 2014, for papers specifying the use of the 'CSM' in relation to 'self-management', 'rehabilitation' and 'adherence' in the context of physical illness. Six hundred abstracts emerged. Data from 52 relevant studies were extracted. Twenty-one studies were meta-analysed, using correlation coefficients in random effects models. The remainder were descriptively synthesised.

RESULTS

The effect sizes for individual illness belief domains and adherence to self-management behaviours ranged from .04 to .13, indicating very weak, predictive relationships. Further analysis revealed that predictive relationships did not differ by the: type of self-management behaviour; acute or chronic illness; or duration of follow-up.

CONCLUSION

Individual illness belief domains, outlined by the CSM, did not predict adherence to self-management behaviours in adults with physical illnesses. Prospective relationships, controlling for past behaviour, also did not emerge. Other factors, including patients' treatment beliefs and inter-relationships between individual illness beliefs domains, may have influenced potential associations with adherence to self-management behaviours.

Further studies to evaluate methods of leucoreduction to prevent alloimmune platelet refractoriness and induce tolerance in a dog platelet transfusion model

OBJECTIVES

Three leucoreduction filters were evaluated - when used alone or combined with centrifuge leucoreduction (C-LR) - to prevent alloimmune platelet refractoriness in a dog platelet transfusion model.

MATERIALS AND METHODS

Donor platelet-rich plasma (PRP) or buffy coat (BC) platelets were either filter leucoreduced (F-LR) or F-LR/C-LR, (51) Cr radiolabelled and transfused. Weekly transfusions were given for up to 8 weeks or until platelet refractoriness. Recipients who accepted treated transfusions were then given non-leucoreduced (non-LR) platelets to determine whether donor-specific tolerance had been induced.

RESULTS

Acceptance of F-LR PRP transfusions ranged from 29% to 66%. F-LR/C-LR transfusions prepared from PRP were accepted by 92%, from BC by 63% and from pooled PRP by 75% of recipients (p=NS); overall acceptance rate of F-LR/C-LR transfusions was 83%. Tolerance to subsequent non-LR transfusions occurred in 45% of the F-LR-/C-LR-accepting recipients unrelated to DR-B compatibility between donors and recipients (P = 0·18).

CONCLUSION

In a dog platelet transfusion model, acceptance of donor platelets required combining F-LR with C-LR as apparently each process removes different immunizing WBCs.

Convergent evolution of health information management and health informatics: a perspective on the future of information professionals in health care

Clearly defined boundaries are disappearing among the activities, sources, and uses of health care data and information managed by health information management (HIM) and health informatics (HI) professionals. Definitions of the professional domains and scopes of practice for HIM and HI are converging with the proliferation of information and communication technologies in health care settings. Convergence is changing both the roles that HIM and HI professionals serve in their organizations as well as the competencies necessary for training future professionals. Many of these changes suggest a blurring of roles and responsibilities with increasingly overlapping curricula, job descriptions, and research agendas. Blurred lines in a highly competitive market create confusion for students and employers. In this essay, we provide some perspective on the changing landscape and suggest a course for the future. First we review the evolving definitions of HIM and HI. We next compare the current domains and competencies, review the characteristics as well as the education and credentialing of both disciplines, and examine areas of convergence. Given the current state, we suggest a path forward to strengthen the contributions HIM and HI professionals and educators make to the evolving health care environment.