A school-based case identification process for identifying inner city children with asthma: the Breathmobile program

BACKGROUND: Striking increases in the prevalence and morbidity of asthma among inner city children have been documented. OBJECTIVE: To establish and evaluate a large-scale, school-based case-detection process designed to efficiently and reliably identify inner city children with asthma. METHODS: A bilingual, seven-question, self-administered, parental asthma screening survey was developed. Clinical validation was achieved in a sample of 675 consecutive parents bringing a child to the school-based Breathmobile Program for initial evaluation, using a comprehensive evaluation by a physician specialist (ie, allergist) as the standard. Survey response patterns were used to construct a novel seven-model, tiered scoring algorithm and an abbreviated algorithm that predict the probability of a child being clinically classified as "yes asthma" or "no asthma." A systematic survey distribution process administered by a single coordinator was developed, and the impact of a classroom-oriented incentive offering a 25 dollars school supply gift certificate for survey return rates of >or= 80% was evaluated. RESULTS: A total of 636 parents provided one or more survey responses and information sufficient for clinical classification. The scoring algorithm correctly identified children with asthma (>or= 80% probability) with a sensitivity of 86.5%, a specificity of 83.6%, and a misclassification rate of 14.3% (91 of 636 children). The sensitivity for identifying persistent asthma was 91.3%. Asthma prevalence estimates derived using survey results from a larger sampling of the general population were similar to rates previously reported for comparable populations. The inclusion of an inexpensive incentive increased the median survey return rates from 35.3 to 65% (z= -11.9; p <.001). The screening process has been used to conduct 27,526 surveys at inner city schools. CONCLUSIONS: The Breathmobile case-detection process offers a validated, comprehensive, large-scale method with which to identify children with asthma at their school sites.     

A comprehensive map of the evidence on the performance evaluation indicators of public hospitals: a scoping study and best fit framework synthesis

Introduction

Key performance indicators are essential navigation tools for hospitals. They provide managers with valid information enabling them to identify institutional strengths and weaknesses and improve managerial performance. In this study, the synthesis of evidence relating to hospital performance indicators was carried out by means of a field review and the indicators were analyzed through the Best Fit Method.

Methods

The five-step approach of Arksey and O’Malley was used as follows: selection of the research question; search for related studies; selection and refinement of the studies; synthesis and tabulation of key information; derivation of the related summary and report. Applying the Best Fit Framework Synthesis Method, the initial themes and subthemes were created and a model of public hospitals performance evaluation finally generated.

Results

Forty-nine studies were considered eligible to form part of the synthesis. The final model included the efficiency/productivity, effectiveness and financial themes. The efficiency/productivity sub-themes incorporated human resources indicators, hospital beds, costs, operating room productivity, emergency rooms, ICU, radiology, labs, technology and equipment productivity. Other sub-themes relate to general indicators such as BOR, ALS, number of outpatients and hospitalized patients. Financial themes included profit, revenue, cash flow, cost, investment, assets, debt and liquidity. Concerning effectiveness, the indicators were categorized in terms of access (equity), safety, quality and responsiveness. The accountability indicators were classified into patient-centeredness, staff orientation, and social responsibility.

Conclusion

Hospital performance management is a multi-dimensional issue, each dimension having its own significance. Based on the evidence, indicators are dependent on the evaluation model employed, the evaluation objective, and the views of executive managers and participants in the study. Selection of the most appropriate indicators is therefore key to a comprehensive performance evaluation system.

     

Comparison of changes in renal function with dosimetric parameters in gastric cancer patients treated with adjuvant chemoradiotherapy

Purpose

Our objective was to analyze kidney damage using glomerular filtration rate (GFR) and dynamic renal scintigraphy (DRS) compared with dose volume histogram (DVH) parameters in gastric cancer patients.

Materials and methods

Twenty-two gastric cancer patients treated with postoperative chemoradiotherapy were retrospectively evaluated. Student’s t test was used to compare pre- and posttreatment GFR and creatinine values. The relative contribution of the left and right kidney in DRS results was expressed as left-to-right ratio (L/R), and the percentage of initial and control participation ratio difference was calculated. Spearman’s correlation analysis was used to compare the percentage difference of L/R ratio with DVH parameters of each kidney.

Results

In DRS analysis, decrease in left kidney cortical function was observed in one patient. V5–V10 of the left and bilateral kidneys were significantly associated with GFR decline. None of the DVH parameter was significantly associated with L/R ratio. However, the V15 and D_mean of the bilateral kidney were significantly correlated with greater decrease in L/R ratio in seven patients whose posttreatment DRS period was > 12 months.

Conclusions

Decline in renal function, even with current renal constraints, was observed. Minimization of V5, V10, and V15 and mean dose (D_mean) to the kidney should be considered.

     

Predicting employment status in multiple sclerosis patients: the utility of the MS functional composite

As many as two-thirds of multiple sclerosis (MS) patients are unable to retain employment. Neurological and cognitive status are known to be significant predictors of unemployment, but the relationship between the two is unclear. Furthermore, the association between employment status and depression, anxiety, and personality has not been adequately explored in MS patients. This study examined the demographic, neurological, neuropsychological, and personality factors associated with unemployment in MS. We also sought to determine the utility of the Multiple Sclerosis Functional Composite (MSFC), a measure of MS-related disability incorporating physical and cognitive measures, in predicting employment status. A consecutive sample of 106 MS patients (61.3% unemployed) completed the Brief Repeatable Battery of Neuropsychological Tests (BRBN), Hospital Anxiety and Depression Scale (HADS), and NEO Five-Factor Personality Inventory. The MSFC emerged as the most robust predictor of employment status in MS patients, exceeding the predictive value of the EDSS. Together with NEO “Agreeableness” and HADS Depression subscore, the MSFC accounted for 49.8% of the variance in employment status. Unemployment was also associated with a progressive disease course, longer disease duration, and being female. While Global Cognitive Impairment did not differentiate between groups, unemployed patients scored significantly lower on three of five BRBN indices: Symbol Digit Modality Test, Paced Auditory Serial Addition Test, and Word List Generation. The findings highlight the utility of the MSFC as a predictor of unemployment in MS. Furthermore, a strong association was found between unemployment and the personality construct “Agreeableness”, and severity of depression.     

Non-interventional Radiology Fellowship Programs: What Is Out There?

ObjectiveTo determine the spectrum of non-interventional radiology fellowship programs in institutions that offer both a radiology residency program and one or more non-interventional radiology fellowship programs.MethodsInstitutions offering both radiology residency and non-interventional radiology fellowship programs were identified using publicly available websites. The non-interventional radiology fellowship programs were categorized into “traditional” (neuroradiology, breast imaging, abdominal imaging, musculoskeletal imaging, thoracic imaging, pediatric radiology, and nuclear medicine) and “nontraditional” fellowship programs. The nontraditional programs were stratified into four categories: a) Combinations of traditional fellowships; b) Focused nontraditional fellowships; c) Combinations of traditional and focused nontraditional fellowships (excluding traditional-traditional combinations); and d) Mandatory two-year fellowships. The distributions of the different types of traditional and nontraditional fellowship programs were evaluated.Results555 fellowship programs were identified in 113 institutions that offered both radiology residency and non-interventional radiology fellowship programs. 73.33% (407/555) of the programs were traditional fellowships, and 26.66% (148/555) were nontraditional fellowships. The 148 nontraditional fellowship programs were comprised of 41 different types of programs, 23 types of which were unique to and offered exclusively at specific institutions. 38.08% of the traditional fellowship programs were Accreditation Council for Graduate Medical Education (ACGME) accredited, while only 16.21% (24/148) of the nontraditional fellowship programs were ACGME-accredited.ConclusionsThe nontraditional non-interventional radiology fellowship programs are formed by a heterogeneous group of programs, some of which are offered exclusively at a single institution. Awareness of the types of existing programs would help radiology residents in making a more informed decision regarding their fellowship training.     

Effect of sandblasting,silica coating,and laser treatment on the microtensile bond strength of a dental zirconia ceramic to resin cements

The purpose of this in vitro study was to evaluate the effect of laser irradiation as well as other surface treatment methods on the microtensile bond strength of a dental zirconia ceramic to the two types of resin cements. Zirconia ceramic blocks (ICE Zirkon) were sintered according to the manufacturer’s instructions and duplicated in resin composites. The ceramic specimens were divided into four groups according to the following surface treatments: no surface treatment (control), sandblasting with alumina, silica coating plus silanization, and Nd:YAG laser irradiation. The specimens were divided equally and then bonded with Panavia F2.0 (self-etching resin cement) and Clearfil SA Luting (self-adhesive resin cement) to the composite blocks. The bonded ceramic-composite blocks were stored in distilled water at 37 °C for 72 h, cut to prepare bar-shaped specimens with a bonding area of approximately 1 mm², and thermocycled for 3000 cycles between 5 and 55 °C, and the microtensile bond strengths were measured using a universal testing machine. The data were analyzed by ANOVA and Tukey post hoc test. The results showed that the self-adhesive resin cement used in this study did not improve the microtensile bond strength when the zirconia surface was sandblasted by alumina. The use of the Nd:YAG laser did not enhance the bond strength between the zirconia and both types of resin cements. In addition, silica coating of the zirconia surfaces plus silane application significantly improved the bond strength regardless of the type of resin cement utilized.