Engaging Radiology Nurses in Quality Improvement Projects in a Women's Specialty Hospital

Measuring outcomes in health care have become mandatory as regulatory agencies, institutional guidelines, employers, and consumer groups advocate for quality health care focusing on improving patient outcomes. System-level quality departments often provide a framework for performance improvement (PI) that supports the organizational PI plan. However, nurses must learn to lead and be actively involved in projects in the radiology department to ensure key performance indicators are developed with on-the-ground quality management to improve patient outcomes, system performance, and professional development. This article explores such efforts at a large women’s specialty hospital in the Southern United States.     

Long-term survival and postoperative complications of pre-liver transplantation transarterial chemoembolisation in hepatocellular carcinoma: A systematic review and meta-analysis

ObjectivesThe aim of this meta-analysis was to conduct a contemporary systematic review of high quality non-randomised controlled trials to determine the effect of pre-liver transplantation (LT) transarterial chemoembolisation (TACE) on long-term survival and complications of hepatocellular carcinoma (HCC) patients.BackgroundTACE is used as a neoadjuvant therapy to mitigate waitlist drop-out for patients with HCC awaiting LT. Previous studies have conflicting conclusions on the effect of TACE on long-term survival and complications of HCC patients undergoing LT.MethodsCINAHL, Cochrane Controlled Register of Trials, Embase, PubMed, and Web of Science were systematically searched. Baseline characteristics included number of patients outside Milan criteria, tumour diameter, MELD score, and time on the waiting list. Primary outcomes included 3- and 5-year overall and disease-free survival. Secondary outcomes included tumour recurrence, 30-day postoperative mortality, and hepatic artery and biliary complications.ResultsTwenty-one high-quality NRCTs representing 8242 patients were included. Tumour diameter was significantly larger in TACE patients (3.49 cm vs 3.15 cm, P = 0.02) and time on the waiting list was significantly longer in TACE patients (4.87 months vs 3.46 months, P = 0.05), while MELD score was significantly higher in non-TACE patients (10.81 vs 12.35, P = 0.005). All primary and secondary outcomes displayed non-significant differences.ConclusionPatients treated with TACE had similar survival and postoperative outcomes to non-TACE patients, however, they had worse prognostic features compared to non-TACE patients. These findings strongly support the current US and European clinical practice guidelines that neoadjuvant TACE can be used for patients with longer expected waiting list times (specifically >6 months). Randomised controlled trials would be needed to increase the quality of evidence.     

Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study

ObjectivesTo confirm what impairments are present in runners with Achilles tendinopathy (AT) and explore the variance of AT severity in an adequately powered study.DesignCase-control study.SettingTwo private physiotherapy clinics in Australia and Spain.ParticipantsForty-four recreational male runners with AT and 44 healthy controls matched by age, height, and weight.Main outcome measuresDemographics, activity (IPAQ-SF), pain and function (VISA-A), pain during hopping (Hop pain VAS), hopping duration, psychological factors (TSK-11, PASS20), and physical tests regarding lower-limb maximal strength and endurance.ResultsBody mass index (BMI), activity, VISA-A, pain, and duration of hopping, TSK-11, PASS20, standing heel raise to failure, seated heel raise and leg extension 6RM, hip extension and abduction isometric torque were significantly different between groups (P < 0.05) with varied effect sizes (V = 0.22, d range = 0.05–4.18). 46% of AT severity variance was explained by higher BMI (β = −0.41; p = 0.001), weaker leg curl 6RM (β = 0.32; p = 0.009), and higher pain during hopping (β = −0.43; p = 0.001).ConclusionRunners with AT had lower activity levels, lower soleus strength, and were less tall. BMI, pain during hopping, and leg curl strength explained condition severity. This information, identified with clinically applicable tools, may guide clinical assessment, and inform intervention development.     

Association between obstructive sleep apnea and floppy eyelid syndrome: A systematic review and metaanalysis

RationaleObstructive sleep apnoea (OSA) has been linked to various ocular disorders, including floppy eyelid syndrome (FES). Previous studies have hypothesised the underlying association between the 2 , but results are currently still inconclusive.ObjectiveTo investigate the association between OSA and FES.MethodsFour databases (Pubmed, Embase, Scopus, and Cochrane Library) were searched from inception until 28 February 2022 for observational studies and randomized controlled trials assessing the association between OSA and FES. Two reviewers selected studies, extracted data, graded the risk of bias using the Newcastle-Ottawa scale and the quality of assessment using the Grading of Recommendations Assessment, Development, and Evaluation system. Random-effects models were used to metaanalyze the associations.ResultsTwelve studies were included in the systematic review, of which nine were suitable for metaanalysis, with a combined cohort of 1,109 patients. Risk of bias was low to moderate. The overall analysis showed a significant positive association between OSA and FES (OR = 1.89, 95% CI = 1.27–2.83, I 2 = 44%). Further analysis revealed that the more severe the OSA was, the higher the risk of developing FES. Patients with severe OSA had the nominally highest risk of developing FES (OR = 3.06, 95% CI = 1.62–5.78, I 2 = 0%), followed by moderate OSA (OR = 2.53, 95% CI = 1.29–4.97, I 2 = 0%), and patients with mild OSA had the lowest risk (OR = 1.76, 95% CI = 0.85–3.62, I 2 = 0%).ConclusionOur metaanalysis reports a positive association between OSA and FES, with increasing severity of OSA correlating with a significantly higher risk of FES. More longitudinal studies with sufficient duration of follow-up are needed to better characterise the relationship between OSA and FES.     

Contemporary Epidemiology of and Risk Factors Associated with Removal of a Pathologically Normal Appendix in Children with Suspected Appendicitis

BackgroundThe goal of this study was to characterize contemporary performance benchmarks and risk factors associated with negative appendectomy (NA) in children with suspected appendicitis.MethodsA multicenter retrospective cohort analysis of children undergoing appendectomy for suspected appendicitis was performed using data from the 2016–2021 NSQIP-Pediatric Appendectomy Targeted Public Use Files. Multivariable regression was used to evaluate the influence of year, age, sex, and WBC count on NA rate, and to generate rate estimates for NA based on different combinations of demographic characteristics and WBC profiles.Results100,322 patients were included from 140 hospitals. The overall NA rate was 2.4%, and rates decreased significantly during the study period (2016: 3.1% vs. 2021: 2.3%, p < 0.001). In adjusted analyses, the highest risk for NA was associated with a normal WBC (<9000/mm³; OR 5.31 [95% CI: 4.87–5.80]), followed by female sex (OR 1.55 [95% CI: 1.42–1.68]) and age <5 years (OR 1.64 [95% CI 1.39, 1.94]). Model-estimated risk for NA varied significantly across demographic and WBC strata, with a 14.4-fold range in rates between subgroups with the lowest and highest predicted risk (males 13–17 years with elevated WBC [1.1%] vs. females 3–4 years with normal WBC [15.8%]).ConclusionsContemporary NA rates have decreased over time, however NA risk remains high in children without a leukocytosis, particularly for girls and children <5 years of age. These data provide contemporary performance benchmarks for NA in children with suspected appendicitis and identify high-risk populations where further efforts to mitigate NA risk should be targeted.Level of EvidenceIII.     

基于CiteSpace的结直肠癌患者生命质量研究

目的：通过中英文文献了解结直肠癌患者生命质量研究现状及发展趋势。方法：运用CiteSpace对中国知网（CNKI）、万方数据知识服务平台、中国生物医学文献数据库、Web of Science核心数据集、PubMed、Cochrane Library中收录的关于结直肠癌患者生命质量研究的中英文文献进行可视化分析。结果：检索得到中文文献1 285篇，英文文献871篇，中英文文献发文量均呈上升趋势，相关研究关注的重点主要是结直肠癌患者造口、抑郁、免疫、肠道功能、化疗及化疗药物，但机构之间、学者之间合作程度及研究类型等方面存在一定差异。结论：中文文献相关研究起步晚、发展快，但在研究质量与研究深度等方面与英文文献相比还有一定差距；国内学者之间、机构之间应加强合作，关心患者肠道功能、心理状况，提高患者体力活动水平，开展更多高质量研究。     

衰减伪影对冠心病患者门控心肌灌注显像图像质量及灌注结果的影响

目的探讨衰减伪影对冠心病患者门控心肌灌注显像(GMPI)图像质量及灌注结果的影响。资料与方法回顾性分析2020年3月—2021年3月在郑州大学第一附属医院核医学科经冠状动脉造影证实且于造影前后1周行GMPI的99例冠心病患者的图像,定性及半定量分析衰减校正前后GMPI图像结果,比较衰减校正前后左心室各壁段平均放射性计数及灌注结果的差异,进一步分析衰减校正前后灌注结果不一致部分的受检者的节段性室壁运动及增厚情况。结果与衰减校正前比较,衰减校正后左心室间隔、下后壁及侧壁的平均放射性计数较高(Z=-7.302、-8.014、-3.991,P均<0.001),心尖部较低(Z=-8.021,P<0.001)。其中女性衰减校正后前壁平均放射性计数减低(Z=-2.314,P=0.021)。男性衰减校正前后下后壁放射性计数差值明显高于女性(t=-8.408,P<0.05)。衰减校正后44%(44/99)的左前降支及37%(37/99)的右冠状动脉分支供血区域显像结果发生改变,结合超声心动图及GMPI结果显示其中85%(35/41)的左前降支及81%(29/36)的右冠状动脉分支供血区域室壁运动及室壁增厚率均正常。结论衰减伪影对GMPI的图像质量和灌注结果有较大影响,结合室壁运动和增厚情况等有助于鉴别衰减伪影,提高诊断准确度与特异度。