We compared the sensitivity of T2-weighted spin-echo (FSE) and fast short-tau inversion-recovery (fSTIR) sequences in detection of multiple sclerosis of the spinal cord in 100 consecutive patients with clinically confirmed multiple sclerosis (MS); 86 patients underwent also brain MRI. In all, 310 focal lesions were detected on fSTIR and 212 on T2-weighted FSE, spinal cord lesions were seen better on fSTIR images, with a higher contrast between the lesion and the normal spinal cord. In 24 patients in whom cord plaques were shown with both sequences, the cranial study was normal or inconclusive. Assessment of spinal plaques can be particularly important when MRI of the brain is inconclusive, and in there situations fSTIR can be helpful.

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are often nonadherent with medications and have poor inhaler technique. Community pharmacists can help to improve health-related quality of life and overall outcomes in patients with COPD. We aim to measure the effectiveness of a systematic, pharmacist-driven intervention on patients with diagnosed COPD.Methods/designThis pragmatic, parallel-group, cluster randomized controlled trial is designed to determine the effectiveness of a multifactorial, pharmacist-led intervention on medication adherence, inhaler technique, health-related quality of life, health care resource utilization including COPD exacerbations, and use of medications. Participating pharmacies in Newfoundland and Labrador (NL), Canada will be randomly assigned to either the intervention or the control group. The intervention group will deliver an enhanced form of care that emphasizes COPD management. The control group will provide usual care and a COPD education pamphlet. Included patients will be aged 40 years or older, have a physician-confirmed diagnosis of COPD, and be able to answer questionnaires in English. The primary outcomes are the between-group difference in the change from baseline to 6 months in medication adherence using the Medication Possession Ratio (MPR) and the Morisky Medication Adherence Scale (MMAS-8). The secondary outcomes are also measured from baseline to 6 months, and include the proportion of patients with a clinically significant change in adherence, the proportion of patients defined as having “good adherence,” the mean MPR between groups, quality of life as measured by the St. George’s Respiratory Questionnaire, medication inhalation technique using a pharmacist-scored checklist, health care resource utilization and antibiotic and orally administered corticosteroid use for COPD exacerbations. Differences between groups will be analyzed at the individual patient level while controlling for clustering effect.DiscussionA pharmacist-led COPD intervention has the potential to improve patient medication adherence, thus increasing quality of life, possibly decreasing pulmonary exacerbations and reducing utilization of acute health care resources. Methods and results taken from this study could be used to enhance the delivery of COPD care by community pharmacists in a real-world setting. This would serve to enhance COPD population health and quality of life.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN) ISRCTN78138190, registered on 3 February 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1623-7) contains supplementary material, which is available to authorized users.

Urinary catheter insertion is one of the most widely performed procedures in a clinical setting. Inexperienced cath- eterizations constitute a high percentage of urethral trauma in hospital settings, with as high as 75% of comorbidities related to inaccurate insertion. Simulation training can help learners feel more confident, shorten the learning curve, and provide a safe learning environment for novices to make, and learn from, mistakes. Three dimensional (3D)- printed simulation models are as effective as commercially available models for novice learners, and have the benefits of being inexpensive, anatomically correct, portable and can be easily modified and rapidly produced as needed. A 3D-printed male urinary catheter insertion simulation model, designed by MUNMed 3D, was offered to Memorial University medical students as part of pre-clerkship procedural training. Fourteen students were provided with a checklist for the procedure and the 3D-printed urinary catheter insertion simulator, and following the simulation, were asked to complete a 5-point Likert survey on their experience.The average self-reported skill before using the model was 1.29 (out of 5), which increased to 3.21 (out of 5). All 14 respondents selected either “agree” or “strongly agree” for the following four survey items: the simulation was an accurate anatomical representation, they would prefer learning on this simulation model before performing this procedure, they would recommend the model to other learners, and they found this model beneficial overall. Simulation training with a 3D-printed urinary catheter insertion simulator allows trainees the opportunity to become confident and familiarize themselves with the procedure before performing it on a real patient.

Introduction: As greater numbers of small renal masses (SRMs) are discovered incidentally, renal tumor biopsy (RTB) is an increasingly recognized step for the management of these lesions, ideally for the prevention of surgical overtreatment for benign disease. While the diagnosis can often be obtained preoperatively by RTB, indeterminate results create greater difficulty for patients and clinicians. This study examines a series of RTBs, identifying the portion of these that were able to yield a diagnosis, and correlates patient factors, including RENAL and PADUA scoring, with the outcome of a non-diagnostic result. Methods: Patients were identified as having undergone RTB at the Princess Margaret Cancer Centre in Ontario, Canada, between January 2000 and December 2009. Data was compiled from these 423 patients and analyzed using CART methodology to determine the level of association between various patient and tumor factors and the outcome of a non-diagnostic biopsy. Tumor size was further used to develop a classification tree to describe the prediction of a non-diagnostic biopsy. Results: Of these 423 patients undergoing RTB, 66 (16%) resulted in a non-diagnostic biopsy. The only patient or tumor factor that was found to be associated with a non-diagnostic outcome was mass size, where small masses (<1.28 cm diameter) were found to have a 38% chance of being non-diagnostic, compared with a 13% chance in those tumors >1.28 cm diameter (86% accuracy, 95% confidence interval [CI] 0.82–0.89). Conclusions: When evaluating SRMs for diagnostic workup, mass size is the only tumor or patient characteristic associated with a non-diagnostic RTB.