Continuous Certification Within Residency: An Educational Model.

Given that maintaining compliance with Maintenance of Certification is necessary for maintaining licensure to practice as a radiologist and provide quality patient care, it is important for radiology residents to practice fulfilling each part of the program during their training not only to prepare for success after graduation but also to adequately learn best practices from the beginning of their professional careers. This article discusses ways to implement continuous certification (called Continuous Residency Certification) as an educational model within the residency training program.

Experience with duplex sonographic evaluation of meso-rex bypass in extrahepatic portal vein obstruction.

Meso-Rex bypass is a surgical procedure for managing extrahepatic portal vein obstruction in children. Although duplex sonography has been used for assessing the patency of the bypass graft and the changes in the intrahepatic portal venous system after the surgery, there was little sonographic description of functioning and dysfunctioning bypass grafts found in the literature. In this case series, we retrospectively evaluated duplex sonography of functioning and dysfunctioning bypass grafts in 5 pediatric patients who received meso-Rex bypass grafts.

Multimodality imaging of an appendiceal intussusception.

Appendiceal intussusception is a rare entity. The majority of cases reported in the literature address surgical and colonoscopic approaches to treatment of the condition. The existing radiologic literature largely describes the sonographic and double-contrast enema findings of appendiceal intussusception.

Doppler ultrasonographic findings on hepatic arterial vasospasm early after liver transplantation.

Objective: Hepatic arterial vasospasm has not been well recognized clinically as a post-liver transplant vascular complication because of the lack of sufficient data and diagnostic standards. The goal of this study was to provide new evidence and a diagnostic model for the clinical appreciation of hepatic arterial vasospasm and evaluate the role of ultrasonography in the diagnostic process.

Methods: Nine post-orthotopic liver transplant cases were retrospectively reviewed.

Diagnostic imaging in the follow-up of nonoperative management of splenic trauma in children.

The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). Contrast-enhanced computed tomography (CT) is approximately 95% sensitive and specific for detection of splenic injury. In children, nonoperative treatment is well-established.

Characteristics of repetitively assaultive patients: ten year analysis of the Assaulted Staff Action Program (ASAP).

The pre-incident components of CISM interventions focus on providing information on risk expectancy as well as cognitive and behavioral resources to enhance coping. This paper studied both the demographic and clinical variables of repetitively assaultive patients in a ten-year analysis of the Assaulted Staff Action Program (ASAP) in an attempt to enhance predictor variables that might be associated with repeat offenders and thus provide staff additional coping resources. Although the demographic variables offered little predictive information, the clinical variable of personal victimization was highly associated with subsequent repeat assault incidents.

Characteristics of assaultive patients with schizophrenia versus personality disorder: six year analysis of the Assaulted Staff Action Program (ASAP).

Literature reviews of individual assaultive patients, repetitively violent patients, and restrained assaultive patients document that persons diagnosed with schizophrenia or personality disorder are at the highest risk to become assaultive. While there has been some initial research of possible predictor variables across diagnostic groups, this six-year retrospective study is the first to compare only persons with schizophrenia or personality disorder on basic demographic and the selected clinical variables of history of violence, personal victimization, and substance use disorder. In this study, the variance suggested that persons with schizophrenia and personality disorder were both likely to be assaultive.

Characteristics of patients in restraint: six year analysis of the Assaulted Staff Action Program (ASAP).

Emergency service providers, including mental health care providers, are often called upon to impose restraint procedures. These procedures may result in physical injury and psychological distress and provide a unique opportunity for emergency mental health personnel to be of assistance. Reviews of the literature on restrained patients have suggested that clinical variables studied need to be added to demographic factors in order to better clarify those at high risk for restraint procedures.

Discovery of OT4003, a novel, potent, and orally active cys-LT1 receptor antagonist.

The present paper describes the structural modifications leading to the discovery of a new series of quinoline-containing cys-LT1 receptor (LTD4 receptor) antagonists. A structural optimization with respect to the in vitro receptor binding, the in vivo brochoconstriction, and the toxicological effect in the form of peroxisomal proliferation was performed in order to achieve the target compound OT4003. OT4003 ((S)-(+)-E-2-(3-(2-(7- chloroquinolin-2-yl)ethenyl)phenylaminomethyl)-phenoxyl++ +-hexanoic acid) was found to be a potent and selective inhibitor of [3H]LTD4 specific binding to guinea pig lung membranes (IC50 2.

The prosecution of violent psychiatric inpatients: one respectable intervention.

Is arrest and prosecution an acceptable response to assault committed by a psychiatric inpatient? The first reported case of such a response was in 1978, and the second not until seven years later. Soon after, an inconclusive debate over the propriety of prosecuting patients, with additional illustrative examples, took place in the psychiatric literature. The present author adds three more case reports in this communication, as well as outlines what actually occurs in his state.

Imaging evaluation of children after falls from a height: review of 45 cases.

The injury pattern in the child who falls from a height is markedly different from that in the adult, so a different imaging protocol is needed. To help establish such a protocol, the authors reviewed the charts and imaging records of 45 children and infants 12 years of age and younger who had fallen one to six stories. Extremity fractures were the most common injury, occurring in 20 patients.

The presence of counsel at forensic psychiatric examinations.

In virtually all situations involving forensic psychiatric assessments, the patient is represented by counsel. But does this fact entitle the lawyer to be present at the clinical evaluation? In a series of New York cases spanning a generation, judges have allowed presence of counsel at the psychiatric examination. The most common reason given for such a conclusion is to assure better cross-examination of the expert witness.

From impartial expert to adversary in the wake of Ake.

In deciding Ake v. Oklahoma, the Supreme Court held that, when defendants demonstrate that their sanity is likely to be a significant factor at trial, the State must assure them access to a competent psychiatrist who will not only examine them but also render other assistance to the defense. There have been 28 known subsequent decisions in which appellate courts have ruled on the validity of Ake-based claims; in only four did the defendant prevail.

Litigating a right to treatment: Woe is me.

The right to treatment was first proposed by Birnbaum in 1960. While its constitutional basis may still be in doubt, it has found significant acceptance in state legislation and in lower court decisions. Defining, implementing, and quantifying this right remain elusive.

Unforeseeable liability for patients' violent acts.

Psychiatrists have been held liable for violent acts committed by their patients when more than an error in professional judgment could be demonstrated. The authors describe several recent court cases in which judges have ignored or distorted acceptable clinical practices, conceivably creating a new liability standard whereby a tragic outcome is considered the result of failure to apply appropriate judgment. Following discussion of the cases are recommendations for managing the risks attendant to psychiatric decision making today, such as gathering as much of the patient's history as possible, obtaining previous records, documenting clinical reasoning, and consulting colleagues.

Pathological gambling and criminal responsibility.

There exists significant interdisciplinary support for eliminating the volitional component of the insanity defense. Somewhat in contrast to this trend is the presentation of pathological gambling as a potentially exculpatory condition in criminal trials. The authors discuss three federal appellate court decisions on this attempted inappropriate usage of psychiatric diagnostic nomenclature.

Incompetent misdemeanants--pseudocivil commitment.

Prior to Jackson v. Indiana, psychiatric hospitalization of those found to be incompetent to stand trial often led to an inordinately long confinement, a particularly invidious consequence if the patient had been accused only of a misdemeanor. After a highly publicized murder perpetrated by a patient originally in this category, New York State instituted a rather cumbersome set of procedures designed to assure several layers of review, including involvement of the legal system, prior to increasing privileges or discharging someone committed pursuant to a criminal court order.