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Kimberly E Applegate

Publications and source records attributed to Kimberly E Applegate.

14 recordsLinked to original sources
PubMed2006

Acute pyomyositis of the pelvis: the spectrum of clinical presentations and MR findings.

BACKGROUND: Acute pelvic pyomyositis is uncommon in non-tropical areas. OBJECTIVE: To summarize the clinical and MR findings in children with acute pelvic pyomyositis. MATERIALS AND METHODS: We retrospectively identified 20 children (mean age 9.4 years) who were evaluated by MR and diagnosed with acute pelvis pyomyositis during the time period between January 2002 and June 2005. We reviewed clinical, laboratory, and imaging findings. RESULTS: Fifteen of the 20 children had secondary pyomyositis associated with osteomyelitis (n=13), septic hip (n=4) or sacroiliitis (n=4); all were previously healthy except for one child with leukemia. Seven of the children with secondary pyomyositis underwent bone scintigraphy; three (43%) did not show pelvic abnormalities. Staphylococcus aureus was cultured in 13 of the 15 (87%) children. Five of the 20 children had primary pyomyositis. Three had underlying disease and two others were engaged in vigorous physical activity. Bone scintigraphies (n=2) were negative. Cultures were positive for S. aureus in three of the five (60%) children. CONCLUSION: Septic hip should be the first diagnostic consideration in children with fever and acute hip pain. Pyomyositis should be considered if arthrocentesis is negative or there is clinical suspicion of infection outside the hip joint. MR is the preferred imaging modality for evaluating foci of pyomyositis, muscle abscesses, and additional foci of infection within the pelvis.

Acute Disease↗
PubMed2005

Mesenteric lymph nodes in children: what is normal?

BACKGROUND: Enlarged mesenteric lymph nodes (MLN) are frequently seen in children with abdominal pain and, in the absence of other disorders, have been attributed to primary mesenteric lymphadenitis. OBJECTIVE: To evaluate the prevalence of enlarged MLN (short axis>or=5 mm) as detected by abdominal CT in children with a low likelihood for mesenteric lymphadenopathy. MATERIALS AND METHODS: During a 14-month period, we identified all non-contrast abdominal CT examinations performed at a tertiary care pediatric hospital for evaluation of suspected or known renal stones. Two radiologists reviewed the examinations and recognized all enlarged MLN, measured the short-axis diameter, and noted the quadrant location. RESULTS: Sixty-one children were identified who met entry criteria; mean age was 10.7 years (range 1.1-17.3 years). Enlarged MLN were found in 33 (54%) of the 61 children; the largest enlarged MLN was most frequently in the right lower quadrant (RLQ) (29 of 33, 88%). Seventeen of the 61 children (28%) had three or more enlarged MLN; all were in the RLQ. The largest short-axis diameter measured was 10 mm. SUMMARY: MLN with a short-axis diameter of >5-10 mm are commonly found on abdominal CT examination of children with a low likelihood for mesenteric lymphadenopathy and should be considered a non-specific finding. A short-axis diameter of 8 mm might better define the upper limit of normal mesenteric lymph node size in children.

Adolescent↗
PubMed2005

Managing risk: threat or opportunity?

OBJECTIVE: Radiologists often regard risk management as a burden or even a threat. This article examines some of the most important reasons every radiologist should regard managing risk as an opportunity. CONCLUSION: There are short-term risks and costs to a program of risk management, but they are far less than the long-range costs of inaction. More importantly, managing risk well is an opportunity to excel as a physician and leader.

Humans↗
PubMed2004

Continuous quality improvement for radiologists.

Continuous quality improvement methods provide a relatively new way to improve quality in healthcare by using a systems approach with key features of customer-mindedness, data collection, experimentation, and teamwork. CQI is not meant to solve simple problems but is increasingly applied in our complex healthcare organizations. In fact, CQI is as much philosophy as it is both a qualitative and quantitative method to assess quality. This review describes the general methods and potential application for radiologists.

Humans↗
PubMed2004

Technology assessment for radiologists.

Health technology assessment is the systematic and quantitative evaluation of the safety, efficacy, and cost of health care interventions. This article outlines aspects of technology assessment of diagnostic imaging. First, it presents a conceptual framework of a hierarchy of levels of efficacy that should guide thinking about imaging test evaluation. In particular, the framework shows how the question answered by most evaluations of imaging tests, "How well does this test distinguish disease from the nondiseased state?" relates to the fundamental questions for all health technology assessment, "How much does this intervention improve the health of people?" and "What is the cost of that improvement?" Second, it describes decision analysis and cost-effectiveness analysis, which are quantitative modeling techniques usually used to answer the two core questions for imaging. Third, it outlines design and operational considerations that are vital if researchers who are conducting an experimental study are to make a quality contribution to technology assessment, either directly through their findings or as an input into decision analyses. Finally, it includes a separate discussion of screening--that is, the application of diagnostic tests to nonsymptomatic populations--because the requirements for good screening tests are different from those for diagnostic tests of symptomatic patients and because the appropriate evaluation methods also differ.

Cost-Benefit Analysis↗
PubMed2004

Statistical literacy.

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed2003

Hypothesis testing III: counts and medians.

Radiology research involves comparisons that deal with the presence or absence of various imaging signs and the accuracy of a diagnosis. In this article, the authors describe the statistical tests that should be used when the data are not distributed normally or when they are categorical variables. These nonparametric tests are used to analyze a 2 x 2 contingency table of categorical data. The tests include the chi2 test, Fisher exact test, and McNemar test. When the data are continuous, different nonparametric tests are used to compare paired samples, such as the Mann-Whitney U test (equivalent to the Wilcoxon rank sum test), the Wilcoxon signed rank test, and the sign test. These nonparametric tests are considered alternatives to the parametric t tests, especially in circumstances in which the assumptions of t tests are not valid. For radiologists to properly weigh the evidence in the literature, they must have a basic understanding of the purpose, assumptions, and limitations of each of these statistical tests.

Diagnostic Imaging↗
PubMed2003

Imaging of acute appendicitis in children.

Acute appendicitis is the most common acute abdominal condition that results in surgical intervention in childhood. The clinical diagnosis of acute appendicitis in children can be challenging. Approximately one-third of children with the condition have atypical clinical findings and are initially managed nonoperatively. Complications associated with delayed diagnosis of this condition include perforation, abscess formation, peritonitis, sepsis, bowel obstruction, infertility, and death. The use of cross sectional imaging has proven useful for the evaluation of suspected acute appendicitis in children. Both graded compression sonography and CT have been widely utilized in the imaging assessment of the condition. The principal advantages of sonography are its lower cost, lack of ionizing radiation, and ability to assess ovarian pathology that can often mimic acute appendicitis in female patients. The principal advantages of CT include less operator dependency than sonography as reflected by a higher diagnostic accuracy, and enhanced delineation of disease extent in perforated appendicitis.

Acute Disease↗
PubMed2002

An introduction to biostatistics.

This introduction to biostatistics and measurement is the first in a series of articles designed to provide Radiology readers with a basic understanding of statistical concepts. Although most readers of the radiology literature know that application of study results to their practice requires an understanding of statistical issues, many may not be fully conversant with how to interpret statistics. The goal of this series is to enhance the ability of radiologists to evaluate the literature competently and critically, not make them into statisticians.

Biometry↗
PubMedDate not supplied

Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series.

Intestinal malrotation, which is defined by a congenital abnormal position of the duodenojejunal junction, may lead to midgut volvulus, a potentially life-threatening complication. An evaluation for malrotation is part of every upper gastrointestinal (GI) tract examination in pediatric patients, particularly neonates and infants. Although the diagnosis of malrotation is often straightforward, the imaging features in approximately 15% of upper GI tract examinations are equivocal and lead to a false-positive or false-negative interpretation. The clinical manifestations and upper GI tract findings of malrotation in older children and adults are less specific than are those in younger patients, and for this reason diagnosis of the condition may be more difficult. Successful differentiation between a normal variant and malrotation requires the use of optimal techniques in acquiring and interpreting the upper GI series. Familiarity with the upper GI series appearance of both normal and abnormal anatomic variants allows the radiologist to increase both diagnostic accuracy and confidence in the diagnosis of malrotation.

Diagnosis, Differential↗