The purpose of this recommendation of the Oncology Task Force of the European Society of Paediatric Radiology (ESPR) is to indicate reasonable applications of whole-body MRI in children with cancer and to address useful protocols to optimize workflow and diagnostic performance. Whole-body MRI as a radiation-free modality has been increasingly performed over the last two decades, and newer applications, as in screening of children with germ-line mutation cancer-related gene defects, are now widely accepted. We aim to provide a comprehensive outline of the diagnostic value for use in daily practice. Based on the results of our task force session in 2018 and the revision in 2019 during the ESPR meeting, we summarized our group's experiences in whole-body MRI. The lack of large evidence by clinical studies is challenging when focusing on a balanced view regarding the impact of whole-body MRI in pediatric oncology. Therefore, the final version of this recommendation was supported by the members of Oncology Task Force.

• MeSH
• celotělové zobrazování metody   MeSH
• dítě MeSH
• konsensus MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• nádory diagnostické zobrazování   MeSH
• poradní výbory MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

AIM: To describe variation in task shifting from GPs to practice assistants/nurses in 34 countries and to explain differences by analysing associations with characteristics of the GPs and their practices and features of the health care systems. BACKGROUND: Redistribution of tasks and responsibilities in primary care are driven by changes in demand, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill-mix of primary care teams. These developments are hampered by barriers between professional domains. METHODS: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7,200 general practitioners (GPs) in 34 countries. Task shifting is measured through a composite score of GPs' self-reported shifting of tasks. Independent variables at GP and practice level are as follows: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are as follows: demand for and supply of care, nurse prescribing, and professionalisation of practice assistants/nurses. Multilevel analysis is used to account for clustering of GPs in countries. FINDINGS: Countries vary in the degree of task shifting. Regarding GP and practice characteristics, use of electronic health records and availability of support staff in the practice are positively associated with task shifting and GPs' working hours negatively, in line with our hypotheses. Age of the GPs is, contrary to our hypothesis, positively related to task shifting. These variables explain 11% of the variance at GP level. Two country variables are related to task shifting: a lower percentage of practices without support staff in a country and nurse prescribing rights coincide with more task shifting. The percentage of practices without support staff has the strongest relationship, explaining 73% of the country variation.

• MeSH
• lidé MeSH
• poskytování zdravotní péče MeSH
• praktické lékařství * MeSH
• praktičtí lékaři * MeSH
• primární zdravotní péče MeSH
• průřezové studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIM: To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. BACKGROUND: Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. METHODS: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable 'task shifting' is measured through a composite score of GPs' self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. FINDINGS: Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.

• MeSH
• lidé MeSH
• poskytování zdravotní péče MeSH
• postoj zdravotnického personálu MeSH
• praktické lékařství * MeSH
• praktičtí lékaři * MeSH
• primární zdravotní péče MeSH
• průřezové studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Globally, health systems are faced with the difficult challenge of how to get the best results with the often limited number of health workers available to them. Exacerbating this challenge is the task of meeting ever-changing needs of service users and managing unprecedented technological advances. The process of matching skills to changing needs and opportunities is termed task shifting. It involves questioning health service goals, what health workers do, asking if it can be done in a better way, and implementing change. Task shifting in healthcare is often conceptualised as a process of transferring responsibility for 'simple' tasks from high-skilled but scarce health workers to those with less expertise and lower pay, and predominantly viewed as a means to reduce costs and promote efficiency. Here we present a position paper based on the work and expertise of the European Commission Expert Panel on Effective ways of Investing in Health. It contends that this is over simplistic, and aims to provide a new task shifting framework, informed by relevant evidence, and a series of recommendations. While far from comprehensive, there is a growing body of evidence that certain tasks traditionally undertaken by one type of health worker can be undertaken by others (or machines), in some cases to a higher standard, thus challenging the persistence of rigid professional boundaries. Task shifting has the potential to contribute to health systems strengthening when accompanied by adequate planning, resources, education, training and transparency.

• MeSH
• lidé MeSH
• poskytování zdravotní péče * MeSH
• zdravotnická zařízení MeSH
• zdravotnický personál * MeSH
• zdravotničtí pracovníci MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Neural components enabling flexible cognition and behavior are well-established, and depend mostly on proper intercommunication within the prefrontal cortex (PFC) and striatum. However, dense projections from the ventral hippocampus (vHPC) alter the functioning of the medial PFC (mPFC). Dysfunctional hippocampo-prefrontal connectivity negatively affects the integrity of flexible cognition, especially in patients with schizophrenia. In this study, we aimed to test the role of the vHPC and mPFC in a place avoidance task on a rotating arena using two spatial flexibility task variants - reversal learning and set-shifting. To achieve this, we inactivated each of these structures in adult male Long-Evans rats by performing bilateral local muscimol (a GABAA receptor agonist) injections. A significantly disrupted performance was observed in reversal learning in the vHPC-inactivated, but not in the mPFC-inactivated rats. These results confirm the notion that the vHPC participates in some forms of behavioral flexibility, especially when spatial cues are needed. It seems, rather unexpectedly, that the mPFC is not taxed in these flexibility tasks on a rotating arena.

• MeSH
• agonisté receptorů GABA-A farmakologie   MeSH
• hipokampus účinky léků   fyziologie   MeSH
• krysa rodu rattus MeSH
• muscimol farmakologie   MeSH
• pozornost účinky léků   fyziologie   MeSH
• prefrontální mozková kůra účinky léků   fyziologie   MeSH
• prostorové vidění účinky léků   fyziologie   MeSH
• reverzní učení účinky léků   fyziologie   MeSH
• učení vyhýbat se účinky léků   fyziologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Neural components enabling flexible cognition and behavior are well-established, and depend mostly on proper intercommunication within the prefrontal cortex (PFC) and striatum. However, dense projections from the ventral hippocampus (vHPC) alter the functioning of the medial PFC (mPFC). Dysfunctional hippocampo-prefrontal connectivity negatively affects the integrity of flexible cognition, especially in patients with schizophrenia. In this study, we aimed to test the role of the vHPC and mPFC in a place avoidance task on a rotating arena using two spatial flexibility task variants - reversal learning and set-shifting. To achieve this, we inactivated each of these structures in adult male Long-Evans rats by performing bilateral local muscimol (a GABAA receptor agonist) injections. A significantly disrupted performance was observed in reversal learning in the vHPC-inactivated, but not in the mPFC-inactivated rats. These results confirm the notion that the vHPC participates in some forms of behavioral flexibility, especially when spatial cues are needed. It seems, rather unexpectedly, that the mPFC is not taxed in these flexibility tasks on a rotating arena.

• MeSH
• agonisté receptorů GABA-A farmakologie   MeSH
• hipokampus účinky léků   fyziologie   MeSH
• krysa rodu rattus MeSH
• muscimol farmakologie   MeSH
• pozornost účinky léků   fyziologie   MeSH
• prefrontální mozková kůra účinky léků   fyziologie   MeSH
• prostorové vidění účinky léků   fyziologie   MeSH
• reverzní učení účinky léků   fyziologie   MeSH
• učení vyhýbat se účinky léků   fyziologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The aim of our study was to analyse decision making in early-onset Parkinson's disease (PD) patients performing the Iowa Gambling Task (IGT). We compared 19 patients with early-onset PD (≤ 45 years) on dopaminergic medication (no evidence of depression, dementia, executive dysfunction according to the Tower of London test and the Stroop test, or pathological gambling) with 20 age-matched controls. A computer version of the IGT was employed. The PD patients achieved slightly lower IGT scores than the control group. A detailed analysis based on 'shift frequencies' between the individual decks showed that the patients tended to change their preferences for the decks more frequently, with a higher preference for the 'disadvantageous' deck B. Control subjects seemed to develop a more effective strategy. These differences could be caused by the poorer ability of the patients to develop any strategy at all. We observed changes in decision making during IGT performance in patients with early-onset PD, although they had no executive dysfunction as measured by established neuropsychological tests. The more detailed analysis employed in the present study could lead to a more accurate study of IGT performance and application of IGT in clinical practice.

• MeSH
• dospělí MeSH
• exekutivní funkce fyziologie   MeSH
• hráčství psychologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuropsychologické testy normy   MeSH
• Parkinsonova nemoc diagnóza   epidemiologie   psychologie   MeSH
• psychomotorický výkon fyziologie   MeSH
• rozhodování fyziologie   MeSH
• věk při počátku nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Paced Auditory Serial-Addition Task (PASAT) is a complex task commonly used to examine patients with diffuse brain damage. A visual version of the neuropsychological test (Paced Visual Serial-Addition Task, PVSAT) has also been introduced to clinical practice, and both versions were adapted to be used in neuroimaging, namely functional magnetic resonance imaging (fMRI). The aim of our work was direct comparison of auditory and visual versions of the paced serial addition test (PASAT/PVSAT) in a within-subject and within-session study and description of the commonalities and differences in both activated and deactivated brain regions. Twenty young adult right-handed healthy volunteers participated in the study and underwent whole-brain fMRI examination during PASAT and PVSAT performance. Higher-level statistical analysis was performed to generate group mean activation and deactivation maps for both tasks, their conjunctions and differences across modalities. In PASAT/PVSAT activation conjunction analysis, we confirmed the existence of a modality-independent neural network similar to working memory tasks and to previous PASAT or PVSAT studies. In PASAT/PVSAT deactivation conjunction analysis, we observed a rather symmetrical extensive pattern of deactivated regions, overlapping the default mode network. Significant differences between PASAT and PVSAT were found in the right frontal eye field (FEF) and bilaterally in the striate and extrastriate cortices. Activation in one task and deactivation in the other jointly contributed to significant differences in all occipital and occipitotemporal regions. Both tasks activated right FEF, but activation during PASAT was significantly stronger than during PVSAT. Between-modality differences should be considered when preparing and interpreting neuroimaging experiments.

• MeSH
• akustická stimulace * MeSH
• dospělí MeSH
• kognice fyziologie   MeSH
• krátkodobá paměť fyziologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mozek fyziologie   MeSH
• neuropsychologické testy MeSH
• plnění a analýza úkolů MeSH
• pozornost fyziologie   MeSH
• světelná stimulace * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The aim of this study was to investigate the functional anatomy of decision-making during the Iowa Gambling Task in patients with Parkinson's disease. We used event-related functional magnetic resonance imaging (fMRI) during a computerized version of IGT to compare 18 PD patients on dopaminergic medication in the ON state and 18 healthy control subjects. Our analyses focused on outcome evaluation following card selection, because we expected this aspect of decision-making to be impaired in PD patients. The PD patients exhibited lower activation of the left putamen than the control group as a reaction to penalty. Using psychophysiological interaction analysis, we identified decreased functional connectivity between the right globus pallidus internus and the left anterior cingulate gyrus in the PD group. In contrast, increased connectivity between these structures was observed after penalty in the control group. Our results suggest altered functioning of the basal ganglia and their connections with the cortical structures involved in the limbic loop (e.g., the limbic fronto-striatal circuit of the basal ganglia) during decision-making in PD patients. Differences in the response to loss could be associated with insufficient negative reinforcement after a loss in PD patients in the ON state in comparison to a healthy population.

• MeSH
• cingulární gyrus patofyziologie   MeSH
• globus pallidus patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mapování mozku MeSH
• neuropsychologické testy MeSH
• Parkinsonova nemoc patofyziologie   MeSH
• putamen patofyziologie   MeSH
• rozhodování fyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVE: Research suggests that disrupted interoception contributes to the development and maintenance of functional neurological disorder (FND); however, no functional neuroimaging studies have examined the processing of interoceptive signals in patients with FND. METHODS: The authors examined univariate and multivariate functional MRI neural responses of 38 patients with mixed FND and 38 healthy control individuals (HCs) during a task exploring goal-directed attention to cardiac interoception-versus-control (exteroception or rest) conditions. The relationships between interoception-related neural responses, heartbeat-counting accuracy, and interoceptive trait prediction error (ITPE) were also investigated for FND patients. RESULTS: When attention was directed to heartbeat signals versus exteroception or rest tasks, FND patients showed decreased neural activations (and reduced coactivations) in the right anterior insula and bilateral dorsal anterior cingulate cortices (among other areas), compared with HCs. For FND patients, heartbeat-counting accuracy was positively correlated with right anterior insula and ventromedial prefrontal activations during interoception versus rest. Cardiac interoceptive accuracy was also correlated with bilateral dorsal anterior cingulate activations in the interoception-versus-exteroception contrast, and neural activations were correlated with ITPE scores, showing inverse relationships to those observed for heartbeat-counting accuracy. CONCLUSIONS: This study identified state and trait interoceptive disruptions in FND patients. Convergent between- and within-group findings contextualize the pathophysiological role of cingulo-insular (salience network) areas across the spectrum of functional seizures and functional movement disorder. These findings provide a starting point for the future development of comprehensive neurophysiological assessments of interoception for FND patients, features that also warrant research as potential prognostic and monitoring biomarkers.

• MeSH
• dospělí MeSH
• interocepce * fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mapování mozku MeSH
• mladý dospělý MeSH
• mozek * patofyziologie   diagnostické zobrazování   MeSH
• nemoci nervového systému * patofyziologie   diagnostické zobrazování   MeSH
• pozornost fyziologie   MeSH
• srdeční frekvence fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH