Our major trauma CT protocol, based on mechanism of injury, resulted in substantial changes in clinical management in a small number of patients without any increase in adverse events. However, it is not a substitute for clinical acumen in the initial assessment of trauma patients.

In total hip arthroplasty, determining the impingement free range of motion requirement is a complex task. This is because in the native hip, motion is restricted by both impingement as well as soft tissue restraint. The aim of this study is to determine a range of motion benchmark which can identify motions which are at risk from impingement and those which are constrained due to soft tissue. Two experimental methodologies were used to determine motions which were limited by impingement and those motions which were limited by both impingement and soft tissue restraint. By comparing these two experimental results, motions which were limited by impingement were able to be separated from those motions which were limited by soft tissue restraint. The results show motions in extension as well as flexion combined with adduction are limited by soft tissue restraint. Motions in flexion, flexion combined with abduction and adduction are at risk from osseous impingement. Consequently, these motions represent where the maximum likely damage will occur in femoroacetabular impingement or at most risk of prosthetic impingement in total hip arthroplasty.Electronic supplementary materialThe online version of this article (doi:10.1007/s11517-012-1016-3) contains supplementary material, which is available to authorized users.

No abstract

Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. A note on versions:The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRAP url' above for details on accessing the published version and note that access may require a subscription. (0) 2476 574 880 Abstract Objective: This study compared the experience of viewing 3D medical images, 2D medical images and no image presented alongside a diagnosis. Methods: We conducted two laboratory experiments, each with 126 healthy participants. Participants heard three diagnoses; one accompanied by 3D medical images, one accompanied by 2D medical images and one with no image. Participants completed a questionnaire after each diagnosis rating their experience. In Experiment 2, half of the participants were informed that image interpretation can be susceptible to errors. Results: Participants preferred to view 3D images alongside a diagnosis (p<.001) and reported greater understanding (p<.001), perceived accuracy (p<.001) and increased trust (p<.001) when the diagnosis was accompanied by an image compared to no image. There was no significant difference in trust between participants who were informed of errors within image interpretation and those who were not. Conclusion: When presented alongside a diagnosis, medical images may aid patient understanding, recall and trust in medical information. Practical Considerations: Medical images may be a powerful resource for patients that could be utilised by clinicians during consultations. KeywordsDoctor-patient communication; patient understanding; recall of medical information; patient trust in medical information.

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A study was conducted to provide an up-to-date analysis of the costs associated with operating an MRI facility in a mainstream National Health Service (NHS) setting. This paper presents an analysis of the costs associated with the acquisition and operation of an MRI scanner installed at the Walsgrave NHS Trust in Coventry in 1988. Costs arising immediately after the introduction of the MRI facility in 1988 are compared with the costs arising towards the end of the scanner's useful life during the 1995/96 financial year. The findings suggest that although the nominal total costs of MRI have increased marginally, from 403,223 Pounds to 434,037 Pounds (an increase of 30,814 Pounds), the increase in total costs is below the rate of inflation, and the nominal average costs of MRI have fallen from 179.20 Pounds to 115.77 Pounds over the period.

The British rail network was privatised in the mid‐ to late 1990s. However, the sector was heavily regulated and not permitted to evolve according to market processes. Indeed, the government imposed a complex and fragmented structure on the industry which ran counter to traditional railway practices. As a consequence, economies of scale and scope were lost, while transaction costs were increased. There was a negative impact on costs and safety. Given the disappointing outcomes, there is a strong case for reforming the sector by facilitating the development of a privately owned and vertically integrated rail system.

Acute and serial chest radiographic appearances of Q-fever in a large UK outbreak in the West Midlands are described. In 69 acute films (taken within 20 days of onset of illness), 10% of films were normal. Appearances in 62 abnormal films were varied and, in contrast to some previous reports, showed no features that might distinguish Q-fever pneumonia from pneumonias of other origins. Analysis of serial films in 47 cases showed that complete radiographic resolution frequently took up to 6 months, longer than has been described previously. Initial appearances deteriorated over the first 2 weeks of radiographic surveillance in 20% of cases. No relationship was found between the extent of radiographic change and the age of the patient or the presence or absence of respiratory symptoms. Age did not affect time to resolution.