Influence of 320-detector-row volume scanning and AAPM report 111 CT dosimetry metrics on size-specific dose estimate: a Monte Carlo study

The American Association of Physicists in Medicine (AAPM) task group 204 has recommended the use of size-dependent conversion factors to calculate size-specific dose estimate (SSDE) values from volume computed tomography dose index (CTDI_vol) values. However, these conversion factors do not consider the effects of 320-detector-row volume computed tomography (CT) examinations or the new CT dosimetry metrics proposed by AAPM task group 111. This study aims to investigate the influence of these examinations and metrics on the conversion factors reported by AAPM task group 204, using Monte Carlo simulations. Simulations were performed modelling a Toshiba Aquilion ONE CT scanner, in order to compute dose values in water for cylindrical phantoms with 8–40-cm diameters at 2-cm intervals for each scanning parameter (tube voltage, bow-tie filter, longitudinal beam width). Then, the conversion factors were obtained by applying exponential regression analysis between the dose values for a given phantom diameter and the phantom diameter combined with various scanning parameters. The conversion factors for each scanning method (helical, axial, or volume scanning) and CT dosimetry method (i.e., the CTDI₁₀₀ method or the AAPM task group 111 method) were in agreement with those reported by AAPM task group 204, within a percentage error of 14.2 % for phantom diameters ≥11.2 cm. The results obtained in this study indicate that the conversion factors previously presented by AAPM task group 204 can be used to provide appropriate SSDE values for 320-detector-row volume CT examinations and the CT dosimetry metrics proposed by the AAPM task group 111.     

The impact of QC frequency on patient results

The expected number of unacceptable patient results due to an undetected, malfunction--E(Nu)--can be set as a patient-based quality goal. Using the number of patients tested between QC specimens as a design parameter allows one to design QC strategies that meet specified patient-based quality goals. The QC utilization rate can be minimized in a QC design for a given E(Nu). The QC-utilization rate achievable depends on how close analytical imprecision is to the total allowable error.     

The incidence and impact of dextrose dose on hyperglycemia from parenteral nutrition (PN) exposure in hematopoietic stem cell transplant (HSCT) recipients

BACKGROUND: Short-term, transient hyperglycemia is associated with adverse outcomes in acutely ill populations. Because parenteral nutrition (PN) is dextrose based, we hypothesized that exposure to PN would be associated with hyperglycemia and that greater levels of dextrose infusion would be associated with higher glucose concentrations. Our objective was to examine the temporality, incidence, and dose response from dextrose load upon hyperglycemia using several serum glucose cut points in PN vs non-PN HSCT recipients. METHODS: The medical records of adults admitted for initial autologous or allogeneic hematopoietic stem cell transplant (HSCT) at 2 university-affiliated hospitals between September 1999 and December 2003 were used in this retrospective cohort. To minimize the impact of disease acuity on serum glucose, patients with diabetes mellitus, steroid administration, patients with recently treated infections, or patients who died during therapy were eliminated from the study. Serum glucose values were recorded once per day from the first morning venous blood draw (2 AM-6 AM) to achieve uniformity among patients, to avoid measurements occurring more frequently among hyperglycemic patients, and to minimize the influence of oral intake. Hyperglycemia was examined using several serum glucose cut points (110, 125, 150, 175, and 200 mg/dL). Wilcoxon rank-sum tests were used to detect differences in hyperglycemic events between PN and non-PN subjects, and mixed-effects regression models were used to detect the association between PN exposure and hyperglycemia. To address the temporality and incidence of hyperglycemia between PN vs non-PN participants, before and "after" time frames were created. Preinfusion (before) and actual infusion (after) times were used for these intervals for PN patients; however, the average hospital days before (before) or during (after) PN infusion were used for comparison in non-PN recipients (ie, autologous non-PN before = hospital days 1-10, after = hospital days 11-21). RESULTS: Of the 208 patients who qualified for inclusion 49% (n = 101/208) received PN, which provided on average 26 kcal per kg, 1.3 g of protein per kg, and 2.7 mg/kg/min of dextrose (range 1.3-3.9 mg/kg/min). The proportion of hyperglycemic days before was not different between groups; however, it was significantly greater after in PN vs non-PN patients, regardless of serum glucose cut point. A dose response between dextrose administered (mg/kg/min) and serum glucose concentrations was not seen. When longitudinally presented, the temporal relationship between serum glucose and PN initiation was reflected approximately on hospital day 9. Using regression models that account for repeated measures, the odds of having hyperglycemia (yes/no; glucose >110 mg/dL) after PN exposure were nearly 4 times (odds ratio 3.9; 95% confidence interval, 2.7-5.5) that of non-PN exposed, after controlling for donor type, race, age, and conditioning chemotherapy. PN was the only variable to significantly interact with time (p < .0001), signifying not only the change in odds over time but also as powerful evidence that PN was the causative agent of hyperglycemic events. CONCLUSIONS: The broad use of PN at levels within current clinical guidelines in HSCT adults was associated with profound hyperglycemia; however, greater dextrose dose, within the narrow levels administered in this cohort, was not associated with higher glucose concentrations.     

The impact of hospital utilization on patient readmission rate

We investigate the issue of patient readmission at a large academic hospital in the U.S. Specifically, we look for evidence that patients discharged when post-operative unit utilization is high are more likely to be readmitted. After examining data from 7,800 surgeries performed in 2007, we conclude that patients who are discharged from a highly utilized post-operative unit are more likely to be readmitted within 72 h. Each additional bed utilized at time of discharge increases the odds of readmission on average by 0.35% (Odds Ratio = 1.008, 95% CI [1.003, 1.012]). We propose that this effect is due to an increased discharge rate when the unit is highly utilized.     

The impact of health system membership on patient safety initiatives

BACKGROUND: Research in configurations and strategic groups has a rich history of revealing performance differences for hospitals and health care systems. PURPOSES: To assess the relationship between hospital-led health system configurations and the adoption of patient safety practices. In particular, the adoption of computerized physician order entry (CPOE) and intensive care unit physician staffing (IPS) is analyzed. METHODOLOGY: Analysis of variance was used to detect differences in patient safety measures based on health networks and systems' initial configuration clustering, and regression was used to assess group membership, controlling for hospital-level characteristics. The 2002 American Hospital Association survey and the first 3 years of the Leapfrog Group annual survey (2003-2005) are used for the analyses. RESULTS: There were significant differences in CPOE and IPS adoption and implementation levels based on health systems' configurations. Centralized physician/insurance health systems and moderately centralized health systems were the highest configurations in terms of CPOE adoption. Group membership was not positively related to the use of IPS relative to hospitals that are not classified using the taxonomy. In fact, there is a significant and negative adoption rate for both patient safety measures in facilities classified in the independent hospital systems category. CONCLUSION: There are systematic differences in the adoption of CPOE and IPS patient safety measures based on health system configurations. The configuration with an insurance company as part of its structure was more likely than other groups to be adopting CPOE. PRACTITIONER IMPLICATIONS: Given the durability of group membership, the Leapfrog Group and other patient safety initiatives could explicitly target configurations most likely to adopt and implement patient safety programs.     

The impact of e-visits on patient access to primary care

To improve patient access to primary care, many healthcare organizations have introduced electronic visits (e-visits) to provide patient-physician communication through secure messages. However, it remains unclear how e-visit affects physicians’ operations on a daily basis and whether it would increase physicians’ panel size. In this study, we consider a primary care physician who has a steady patient panel and manages patients’ office and e-visits, as well as other indirect care tasks. We use queueing-based performance outcomes to evaluate the performance of care delivery. The results suggest that improved operational efficiency is achieved only when the service time of e-visits is smaller enough to compensate the effectiveness loss due to online communications. A simple approximation formula of the relationship between e-visit service time and e-visit to office visit referral ratio is provided serving as a guideline for evaluating the performance of e-visit implementation. Furthermore, based on the analysis of the impact of e-visits on physician’s capacity, we conclude that it is not the more e-visits the better, and the condition for maximal panel size is investigated. Finally, the expected outcomes of implementing e-visits at Dean East Clinic are discussed.     

The impact of electronic patient records on workflow in general practice

The Patient Access to Electronic Healthcare Records System (PAERS) allows patients to register their arrival at a GP's surgery and to view their healthcare record electronically whilst in the waiting area. The research reported in this short article was carried out to identify potential changes in clinical and administrative workflow resulting from the introduction of the system. The study considers workflow pre and post the implementation of PAERS. It also makes comparisons between two UK London-based surgeries, one with PAERS (Wells Park Practice) and one without such a system (South Lewisham Group Practice). The impact of PAERS on workflow and the potential benefits for GPs, administrative staff and patients are highlighted.     

The impact of unit-based self-management by nurses on patient outcomes.

OBJECTIVE. Patients discharged from a self-managed nursing unit are compared with patients from traditionally managed units on postdischarge outcomes. DATA SOURCES AND STUDY SETTING. Primary data were collected on patients discharged from eight nursing units in three clinical areas in one hospital from August through November 1990. STUDY DESIGN. A case series of eligible patients discharged from four self-managed nursing units (n = 140) are compared with patients from four matched traditionally managed units (n = 138) on postdischarge outcomes: perceived health status, perceived functional status, needs for care, unmet needs for care, unplanned health care visits, and readmissions to the hospital within 31 days of discharge. DATA COLLECTION METHODS. Patients were interviewed by telephone at approximately two weeks postdischarge, and data from hospital records were merged with interview data. PRINCIPAL FINDINGS. Bivariate and multiple logistic regression analyses showed no significant effects (either positive or negative) of self-managed units on the postdischarge outcomes studied. CONCLUSIONS. Self-managed nursing units, previously shown to improve nurses' work satisfaction and retention, have no impact on patient postdischarge outcomes.     

Evaluation of the impact of the source (patient versus staff) on nosocomial norovirus outbreak severity.

OBJECTIVE: To study the dependence of infection risk and outbreak size on the type of index case (i.e., patient or staff). METHODS: Nosocomial outbreaks were reviewed and categorized into those started by patients and those started by staff. Infection risks and outbreak sizes were evaluated taking into account the index case category. RESULTS: Of the 30 nosocomial outbreaks of norovirus with person-to-person transmission, 20 (67%) involved patients as the index cases. Patient-indexed outbreaks affected significantly more patients than did staff-indexed outbreaks (difference in means, 16.25; 95% confidence interval [CI95], 5.1 to 27.0). For the numbers of affected staff, no dependence on the index case category was detectable (difference in means, -1.05; CI95, -9.0 to 6.9). For patients exposed during patient-indexed outbreaks, the risk of acquiring a norovirus infection was approximately 4.8 times as high as the corresponding risk for patients exposed during staff-indexed outbreaks (odds ratio [OR], 4.79; CI95, 1.82 to 8.28). The infection risk for exposed staff during patient-indexed outbreaks was approximately 1.5 times as high as the corresponding risk during staff-indexed outbreaks (OR, 1.51; CI95, 0.92 to 2.49). CONCLUSIONS: Patient-indexed norovirus outbreaks generally affect more patients than do staff-indexed outbreaks. Staff appear to be similarly affected by both outbreak index category groups. This study demonstrates the importance of obtaining complete outbreak data, including the index case classification as staff or patient, during norovirus outbreak investigations. Such information may be useful for further targeting prevention measures     

The impact of family presence on the physician-cancer patient interaction.

Physician behaviors were studied in 473 interactions between oncologists and adult cancer outpatients. Ninety-nine of these interactions occurred when family members were present during the visit. Patients with family members present were likely to be sicker as demonstrated by a poorer performance status. Contrary to earlier reports, age of the patient did not predict whether the patient was likely to be accompanied by a family member. The physician behaviors were factor analyzed to produce six factors and a multivariate analysis of variance was conducted using the presence of family and performance status as independent variables. The time the physician spent in the patient's room, patient satisfaction and quality of life were also examined in separate analyses. The time the physician spent with the patient was greater when family were present. The results showed that, in general, physicians provide more information when patients are accompanied by family members, or if no family are present, when the patient has a worse performance status. Patient satisfaction and quality of life were rated lower for patients with a worse performance status and were not impacted by physician behaviors. Physicians' behavior was affected by both the presence of a family member, and the patient's performance status.     

The coronavirus (COVID-19) pandemic's impact on mental health

Throughout the world, the public is being informed about the physical effects of SARS-CoV-2 infection and steps to take to prevent exposure to the coronavirus and manage symptoms of COVID-19 if they appear. However, the effects of this pandemic on one's mental health have not been studied at length and are still not known. As all efforts are focused on understanding the epidemiology, clinical features, transmission patterns, and management of the COVID-19 outbreak, there has been very little concern expressed over the effects on one's mental health and on strategies to prevent stigmatization. People's behavior may greatly affect the pandemic's dynamic by altering the severity, transmission, disease flow, and repercussions. The present situation requires raising awareness in public, which can be helpful to deal with this calamity. This perspective article provides a detailed overview of the effects of the COVID-19 outbreak on the mental health of people.     

The impact of phospholipid transfer protein (PLTP) on lipoprotein metabolism

ABSTRACT: It has been reported that phospholipid transfer protein (PLTP) is an independent risk factor for human coronary artery disease. In mouse models, it has been demonstrated that PLTP overexpression induces atherosclerosis, while its deficiency reduces it. PLTP is considered a promising target for pharmacological intervention to treat atherosclerosis. However, we must still answer a number of questions before its pharmaceutical potential can be fully explored. In this review, we summarized the recent progresses made in the PLTP research field and focused on its effect on apoB-containing- triglyceride-rich particle and HDL metabolism.