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Objectives Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age Methods PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool. Results Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age ≥ 65), and 2 on caregiver burden (1 study with mean age ≥ 65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences. Conclusions and implications VSN has a negative impact not only on patients’ independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN should be systematically and carefully assessed during rehabilitation. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice. Systematic review Registration No. PROSPERPO Registration No. CRD42018087483.

Purpose; Returning to community living is an indicator for successful rehabilitation in older adults admittedto geriatric rehabilitation. Predicting successful rehabilitation could contribute to the deployment of earlydischarge planning, and leads to a more custom-made rehabilitation trajectory. This review aims to presentan overview of factors associated with successful rehabilitation following inpatient geriatric rehabilitation.Method; A systematic literature review was conducted in PubMed, CINAHL and Embase. Extracted factorswere analysed via Bakker’s five levels of evidence.Results; Nine studies with methodological quality of good to moderate were included. For 13 of the 18 extractedfactors, limited (n=3),moderate (n=5) and conflicting (n=5) evidence found a significant association.Conclusions; Caregiver, comorbidities, motor-function, nutritional status, time from onset are significantlyrelated to successful rehabilitation. These factors could support healthcare professionals to indicate successfulrehabilitation at admission and contributes to deployment of early discharge planning and developmentof more custom-made rehabilitation trajectories.

Accurate spatial dose delivery in radiotherapy is frequently complicated due to changes in the patient’s internal anatomy during and in-between therapy segments. The recent introduction of hybrid MRI radiotherapy systems allows unequaled soft-tissue visualization during radiation delivery and can be used for dose reconstruction to quantify the impact of motion. To this end, knowledge of anatomical deformations obtained from continuous monitoring during treatment has to be combined with information on the spatio-temporal dose delivery to perform motion-compensated dose accumulation (MCDA). Here, the influence of the choice of deformable image registration algorithm, dose warping strategy, and magnetic resonance image resolution and signal-to-noise-ratio on the resulting MCDA is investigated. For a quantitative investigation, four 4D MRI-datasets representing typical patient observed motion patterns are generated using finite element modeling and serve as a gold standard. Energy delivery is simulated intra-fractionally in the deformed image space and, subsequently, MCDA-processed. Finally, the results are substantiated by comparing MCDA strategies on clinically acquired patient data. It is shown that MCDA is needed for correct quantitative dose reconstruction. For prostate treatments, using the energy per mass transfer dose warping strategy has the largest influence on decreasing dose estimation errors.

Purpose The aim of this study was to determine whether direct verbal communication of results by a radiologist affected follow-up compliance rates for probably benign breast imaging findings. Methods This study was institutional review board approved and HIPAA compliant. A retrospective search identified all patients from January 1, 2010 to December 31, 2010 who had breast findings newly assessed as probably benign (BI-RADS category 3). Patients were categorized by whether the radiologist or the technologist verbally communicated the result and follow-up recommendation. Patient adherence to 6-, 12-, and 24-month follow-up imaging recommendations was recorded. Results Compliance data were available for 770 of 819 patients in the study. Overall compliance was 83.0% (639 of 770) for 6-month examinations, 68.1% (524 of 770) for 6- and 12-month examinations, and 57.4% (442 of 770) for 6-, 12-, and 24-month examinations. For patients who initially underwent diagnostic mammography alone, there was no significant difference in compliance between those who had and those who did not have radiologist-patient communication (6 months, 81.9% vs 80.8% [ P = .83]; 6 and 12 months, 70.8% vs 67.3% [ P = .58]; 6, 12, and 24 months, 54.2% vs 58.4% [ P = .53]). For patients who initially underwent diagnostic mammography alone versus ultrasound with or without diagnostic mammography, there was no significant difference in compliance (6 months, 81.1% vs 84.3% [ P = .24]; 6 and 12 months, 68.1% vs 68.0% [ P = .96]; 6, 12, and 24 months, 57.4% vs 57.4% [ P = .00]). Conclusions High initial compliance was achieved by radiologist or technologist verbal communication of findings and recommendations. Direct communication by the radiologist did not increase compliance compared with communication by a technologist.

In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted.

Intravenous antibiotics and enteral tube feeding at home for the treatment of pulmonary exacerbations and underweight condition in cystic fibrosis (CF) patients have become tools that are used in many cystic fibrosis centres. The experience with home care programmes from different countries is quite conclusive. If the necessary preparations are made, such as training of staff and patients, and financial support is arranged, home care is easy to put into practice. Optimal patient compliance is also necessary. Home care is as effective as hospital treatment for selected patients, and less expensive. Experience has increased during many treatment periods in different cystic fibrosis centres, and only a few adverse events have been recorded, indicating that home care is safe. However, the most important gain for cystic fibrosis patients is the reduction of hospital admission time, which means a definite improvement in the quality of life.

Since 1982, 229 terminally ill cancer pain patients were treated by the administration of epidural opioids. An adequate level of aid was provided by the coordinated efforts of the patients' general practitioner, the district nurse, and the anesthesiologist. Based on 9 yr of experience with this model, a project on quality improvement and organization of cancer pain control by infusion techniques in the home situation was proposed. The purpose of the study is to create a nationwide organization for cancer pain control for terminal patients on a home-care basis. Specially trained ambulatory field teams will be set up to collect and process the information necessary to make protocols and instructions.

Aortic ulcerlike projections are focal, contrast-filled outpouchings projecting from the aortic lumen. Our aim was to document the CT findings and natural history of ulcerlike projections developing in patients with preexisting noncommunicating aortic dissection, including intramural hematoma or false lumen thrombosis.By searching the radiology information system, we found 38 ulcerlike projections arising in an underlying noncommunicating aortic dissection that were identified at CT in 24 patients. Clinical factors were determined from patient records. CT scans were reviewed to determine aortic pathology type and appearance time of ulcerlike projections and to measure the diameters of the aorta and ulcerlike projections for comparison over time. Complications were defined as an increase of at least 20% in the diameters of the ulcerlike projections or aorta, the need for surgical repair, or both. Comparisons of ulcerlike projections with and without complications were performed using various statistical tests.The underlying aortic disease of the 38 ulcerlike projections was intramural hematoma in 26, false lumen thrombosis in nine, and unknown in three. The mean time of ulcerlike projection appearance was 2.4 months (SD, 1.8) for intramural hematoma and 19.3 months (SD, 18.1) for false lumen thrombosis. Nine of the 28 ulcerlike projections with follow-up scans showed stability, size decrease, or resolution; 10 increased in size; and nine were incorporated into an expanded aortic lumen. Four of 36 ulcerlike projections with imaging or clinical follow-up (or both) required surgical repair. The only clinical or imaging feature significantly associated with the development of complications was false lumen thrombosis (p = 0.04).Ulcerlike projections forming in noncommunicating dissections may enlarge over time, although they rarely require surgical repair. Given the potential for critical complications, these lesions should be followed with serial CT scans.