Theoretically-driven infrastructure for supporting health care teams training at a military treatment facility

Designated a Department of Defense Team Resource Center (TRC) in 2008, Naval Medical Center Portsmouth (NMCP) currently hosts three tri-service health care teams training courses annually. Each consists of didactic learning coupled with simulation-based training exercises to provide an interactive educational experience for health care professionals. Simulated cases are developed to reinforce specific teamwork skills and behaviors, and to incorporate a variety of technologies including standardized patients, manikins, and virtual reality. The course is also the foundation of a research program designed to explore applications of modeling and simulation for enhanced team training in health care. The TRC has adopted two theoretical frameworks for evaluating training efficacy and outcomes, and has used these frameworks to guide a systematic reconfiguration of the infrastructure supporting health care teams training at NMCP.     

Assessing the institutional approach to implementing smoking cessation practice guidelines in veterans health administration facilities

National smoking cessation guidelines include recommended strategies for providers and health care organizations, but they offer little guidance on how to structure care. We conducted a cross-sectional survey at 40 Veterans Health Administration facilities, to describe the structure of smoking cessation care, to assess adherence to national guidelines, and to assess facilities' preferred approach to providing smoking cessation treatment. We categorized sites as those using a primary care approach (most smokers treated by the primary care provider) versus a specialty approach (medication restricted to smoking cessation clinics, to which most patients were referred). Nearly all sites reported systematic screening for smoking and counseling of smokers, usually by both nursing staff members and the primary care provider. Most sites used a specialty approach, restricting medication access to smokers attending a cessation program. Future research should evaluate whether this approach provides adequate access and responsiveness to patient preferences for the full population of smokers in primary care.     

Mock trial at 2009 RSNA annual meeting: Jury exonerates radiologist for failure to communicate abnormal finding--but...

On the morning of Sunday November 29, 2009, hundreds of radiologist-attendees at the Radiological Society of North America's Scientific Assembly and Annual Meeting took their seats in a simulated courtroom at McCormick Place, Chicago, Ill, to witness a mock trial of a radiologist who had been accused of medical malpractice for failing to communicate to a referring physician a possibly important abnormal radiologic finding. This report is a summary of the lawsuit. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100927/-/DC1.     

Outcome analysis for women undergoing annual versus biennial screening mammography: a review of 24,211 examinations.

OBJECTIVE: Our goal was to determine differences in outcome measures between women undergoing annual versus biennial screening mammography. MATERIALS AND METHODS: A retrospective review of prospectively collected data on 24,211 consecutive screening mammography examinations was performed in women aged 40-79 years, all of whom had undergone previous normal screening mammography. Annual screening and biennial screening were defined as examinations performed 10-14 months and 22-26 months, respectively, after previous normal screening mammography. The rates of recall, biopsy, cancer detection, and interval cancer for annual and biennial screening cohorts were calculated, as were tumor size, lymph node status, and stage of invasive cancer. Interval cancer cases were identified by linkage with a regional tumor registry. RESULTS: Of the 4306 biennially screened women, 160 were recalled (3.7%), 45 were biopsied (1.0%), and cancer was detected in 19 (0.44%). Of the 19,905 annually screened women, 518 were recalled (2.6%), 150 were biopsied (0.75%), and cancer was detected in 71 (0.36%). Of the 3278 registry-linked biennially screened women, five had interval cancer (0.15%); of the 15,031 registry-linked annually screened women, 10 had interval cancer (0.07%). For biennial screening-detected cancer and interval invasive cancer combined, the median tumor size was 15 mm, 24% had lymph node metastasis, and 29% were stage 2 or higher. For annual screening-detected cancer, these measures were 11 mm, 14% positive nodes, and 17% stage 2+ cancer, respectively. CONCLUSION: Annual screening mammography results in lower recall rates than does biennial screening (p < .0001). Moreover, annual screening results in the detection of smaller tumors that have a more favorable prognosis (p = .04).     

Primary care providers' attitudes toward prostate cancer risk factors at a Veterans Affairs health care facility

OBJECTIVE: We asked what factors influence primary care providers' decision to screen patients for prostate cancer. METHODS: A survey completed by 175 Veterans Affairs primary care providers queried whether patient anxiety, family history, race, and other assorted risk factors increased their likelihood of screening for prostate cancer. Subsequent questions assessed the degree to which various factors, such as age, comorbidities, and lack of interest, decreased their likelihood of screening. RESULTS: The African American race increased the tendency for screening for 84.6%, followed by a family history of prostate cancer for 73.3%. Life expectancy of less than 5 years substantially decreased the tendency to screen for only 42.3%. Only 28% thought that age of more than 75 years was a deterrent to screening. CONCLUSIONS: Veterans Affairs primary care providers recognize the need to aggressively screen African Americans and men with a family history of prostate cancer. However, they often screen men with a limited life expectancy or advanced age.     

Job satisfaction among nursing staff in a military health care facility

Job satisfaction in the workplace affects absenteeism, turnover, and performance. We conducted a cross-sectional study of 201 nursing personnel to assess satisfaction among nursing staff at a military hospital in the southwestern United States. Participants completed a self-administered survey in which they rated professional status, autonomy, pay, organizational policies, task requirements, and interaction by importance and satisfaction. Autonomy, professional status, and pay were the most important factors and organizational policies was the least important factor. Military staff were slightly more satisfied with staff interactions than civilian staff. Nursing personnel working in specialty care units were significantly more satisfied with interactions and professional status, but they valued organizational policies less than those working in general units. Professionals were significantly more satisfied with pay and autonomy, whereas nonprofessionals were more satisfied with task requirements and professional status.     

Risk of medical events in a supervised health and fitness facility.

PURPOSE: This prospective epidemiological study examined the incidence of medical events during participation in a supervised health and fitness facility at a major medical center. METHODS: Participants consisted of 7725 members of a corporate health and fitness program. Risk was defined by number of medical incidents per total number of event episodes multiplied by the average time of activity per episode (1000 participant-hours). RESULTS: The first 2.5 yr of surveillance revealed 15 reported medically significant events (.048 per 1000 participant-hours). There were two medical emergencies yielding a rate of .0063 per 1000 participant-hours. CONCLUSION: The results of this study support the position that the expected health benefits of participation in a physical activity program at a supervised health and fitness facility outweigh the risks of such participation.     

河南省某市放射工作人员职业健康检查项目未检率调查分析

目的 了解放射工作人员职业健康检查项目未检情况。方法 选取2019年河南省平顶山市1 019名放射工作人员职业健康检查资料,对各检查项目[个人基本信息资料采集、血压、内科常规、皮肤科、眼科（色觉、视力,眼晶状体裂隙灯检查、玻璃体、眼底）、DR胸片、彩超（腹部及甲状腺）、心电图、血液检查（血常规、生化检验、甲状腺功能、外周血淋巴细胞微核试验或外周血淋巴细胞染色体畸变分析）、尿常规]未检率及按照不同职业受照类别、性别、年龄组、不同级别医疗机构的各检查项目未检率进行统计分析。结果 1 019名放射工作人员各检查项目未检率差异有统计学意义（χ²=2 580.657,P<0.05）,其中DR胸片未检率最高,为46.0%,其次为尿常规（9.3%）,只有血液检查未检率最低为0。就不同分类来说,放射工作人员各检查项目总体未检率,医学应用高于工业应用（χ²=93.969,P<0.05）;女性高于男性（χ²=24.228,P<0.05）;不同年龄组中,<30岁最高,其次≥50岁,40~岁最低（χ²=12.623,P<0.05）;医疗机构单位级别越高总体未检率越高（χ²=24.725,P<0.05）;医学应用不同职业受照类别中,放射诊断学>介入放射学>放射诊疗（χ²=23.263,P<0.05）。不同分类中各检查项目未检率,医学应用高于工业应用的有DR胸片、腹部彩超、甲状腺彩超、心电图、尿常规（χ²=141.776、13.801、11.228、5.465、4.825,P<0.05）;女性高于男性的有DR胸片、尿常规（χ²=43.032、23.247,P<0.05）;不同年龄组中,色觉及视力、DR胸片、甲状腺彩超、尿常规未检率差异均有统计学意义（χ²=14.285、9.519、7.958、16.656,P<0.05）;不同级别医疗机构中,色觉及视力、DR胸片、心电图未检率差异均有统计学意义（χ²=12.328、29.831、15.342,P<0.05）;医学应用不同职业受照类别中,DR胸片、尿常规未检率差异均有统计学意义（χ²=46.519、14.109,P<0.05）。结论 应继续加强放射工作人员健康管理,严格按照国家相关要求进行职业健康检查。     

Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers

The aim of this study was analysis of incidence results in a prospective one-arm feasibility study of lung cancer screening with low-radiation-dose spiral computed tomography in heavy smokers. Eight hundred seventeen smokers (40 years, 20 pack years of smoking history) underwent baseline low-dose CT. Biopsy was recommended in nodules >10 mm with CT morphology suggesting malignancy. In all other lesions follow-up with low-dose CT was recommended. Annual repeat CT was offered to all study participants. Six hundred sixty-eight (81.8%) of the 817 subjects underwent annual repeat CT with a total of 1735 follow-up years. Follow-up of non-calcified nodules present at baseline CT demonstrated growth in 11 of 792 subjects. Biopsy was performed in 8 of 11 growing nodules 7 of which represented lung cancer. Of 174 new nodules, 3 represented lung cancer. The 10 screen-detected lung cancers were all non-small cell cancer (6 stage IA, 1 stage IB, 1 stage IIIA, 2 stage IV). Five symptom-diagnosed cancers (2 small cell lung cancer: 1 limited disease, 1 extensive disease, 3 central/endobronchial non-small cell lung cancer, 2 stage IIIA, 1 stage IIIB) were diagnosed because of symptoms in the 12-month interval between two annual CT scans. Incidence of lung cancer was lower than prevalence, screen-detected cancers were smaller, and stage I was found in 70% (7 of 10) of screen-detected tumors. Only 27% (4 of 15) of invasive procedures was performed for benign lesions; however, 33% (5 of 15) of all cancers diagnosed in the population were symptom-diagnosed cancers (3 central NSCLC, all stage III, 2 SCLC) demonstrating the limitations of CT screening.     

Clearance measurement of metal scraps for nuclear facility at INER in Taiwan

The nuclear facilities at Institute of Nuclear Energy Research (INER) had been successively decommissioned and decontaminated over the recent years. Since dismantling was a complex task, to achieve the main goal was minimization of radioactive waste production and required the set-up of procedures, criteria of free release, strict follow-up and traceability at all steps. This study gave an overview of the efforts on non-destructive assay (NDA) of relatively large volumes of waste and the sampling of contaminated waste with radiochemical analysis was utilized to determine the radionuclide vectors. The experiences of free release planning and measurement of a very low level radioactivity with high throughput for scrapped metal at the INER and the technical achievements in this research could offer a reference of decision-making by the competent authority.     

Challenges faced by women in radiology during the pandemic - A summary of the AAWR Women's Caucus at the ACR 2020 annual meeting

The COVID-19 pandemic has dramatically altered the professional and personal lives of radiologists and radiation oncologists. This article summarizes the 2020 American Association for Women in Radiology (AAWR) Women's Caucus at the American College of Radiology (ACR) Annual Meeting. The caucus focused on the major challenges that women in radiology have faced during the pandemic.     

A model for self-directed learning in a military facility

Continuing education for health care providers presents an ongoing challenge in an environment of personnel limitations and budget constraints. Learning is a constant requirement for safe and effective health care practice; in addition, it is often a requirement for licensure. The purpose of this article is to review a model of distance learning as a method of education to meet the needs of a multidisciplinary staff, applicable to all services and types of personnel. The model was implemented in the Department of Nursing at Madigan Army Medical Center. The results were deemed highly successful after 1 year, considering the large number of contact hours completed and the relatively low cost invested. The conclusion indicates that distance learning provides a high level of knowledge attainment available 24 hours a day, even at remote military settings and outlying facilities.