Time Tracking of Standard Ultrasound Examinations in Pediatric Hospitals and Pediatric Medical Practices – A Multicenter Study by the Pediatric Section of the German Society of Ultrasound in Medicine (DEGUM)

2019 ◽  
Author(s):  
Adrian P. Regensburger ◽  
Ferdinand Knieling ◽  
Axel Feldkamp ◽  
Wolfgang Rascher ◽  
Katharina Diesch ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Ultrasound Examination ◽  
Imaging Modality ◽  
Total Duration ◽  
National Data ◽  
University Hospitals ◽  
Total N ◽  
Medical Practices ◽  
Pediatric Section ◽  
Organ Systems

Abstract Purpose Ultrasonography is the primary imaging modality in pediatrics but still lacks sufficient reimbursement in Germany. In this multicenter study, national data for the duration of standard ultrasound in pediatrics were systematically documented in order to specify the actual time required. Materials and Methods N = 10 hospitals (N = 5 university hospitals, N = 5 non-university hospitals) and N = 3 medical practices in Germany recorded the entire process of an ultrasound examination in a special protocol developed by the Pediatric Section of the DEGUM. The duration of each of seven single steps during ultrasonography (from data input to final discussion of the results) of different organ systems was logged. Results In total, N = 2118 examinations from different organ systems were recorded. N = 10 organ systems were examined frequently (> 30 times). The total duration of an ultrasound examination was statistically significantly longer in hospitals compared to medical practices (median (IQR) 27 min. (18–38) vs. 12 min. (9–17), p < 0.001). The “hands-on” patient time was approximately one half of the total required time in both settings (49.9 % vs. 48.9 %). Ultrasonography of the abdomen and brain lasted longer in university hospitals than in non-university hospitals (p < 0.001, and p = 0.04, respectively). Cooperation and age did not uniformly correlate with the total duration. Conclusion This study provides novel comprehensive national data for the duration of standardized ultrasound examinations of children and adolescents in Germany. These data are essential for a further evaluation of the economic costs and should support better remuneration in the future.

Role of MRI in Screening of Non-Traumatic Pediatrics Hip Pain

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Abeer Abd El Maksoud Hafez ◽  
Tarek Wahby Hameda ◽  
Ghadier Ibrahim Attia
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Hip Joint ◽  
Imaging Modality ◽  
Bone Cyst ◽  
Hip Pain ◽  
Joint Effusion ◽  
Resonance Imaging ◽  
University Hospitals ◽  
Great Ability

Abstract Background Magnetic resonance is the best imaging modality to assess hip joint in non-traumatic cases. It has a great ability to diagnose disorders of bone, cartilage, ligaments, muscles and soft tissue. MRI can also detect joint effusion and bone marrow edema. Aim of the Work: To assess the value of MRI as the imaging modality in children presenting with acute non-traumatic hip pain and its ability to assess the cause of the pain early without the use of another imaging modality. Patients and Methods A retrospective study was conducted on pediatric patients with non-traumatic hip pain, referred from the outpatient pediatric clinic, orthopedic clinic, Ain Shams University hospitals. The patients were investigated using magnetic resonance imaging (MRI) for detection the cause of non-traumatic hip pain. Results In this study we found that avascular necrosis is the commonest cause of non-traumatic hip pain followed by isolated hip effusion then synovitis. Other causes included perthes, septic arthritis, osteomyelitis, aneurysmal bone cyst, SCFE, PFFD and Osteomalacia. Magnetic resonance imaging doesn’t only demonstrate disorders of hip joint only; it also gives an accurate assessment of other extra-articular causes of referred hip pain. Conclusion Hip MRI is a practical, well accepted and accurate non-invasive imaging technique in children presenting with acute non-traumatic hip pain.

scholarly journals Bacterial contamination of stethoscopes in university hospitals: Multicenter study

2015 ◽  
Vol 66 (2) ◽  
pp. 55-60
Author(s):  
Stefan Boskovic ◽  
Karim Sharawy ◽  
Alonso Rodriguez
Keyword(s):  
Multicenter Study ◽  
Bacterial Contamination ◽  
University Hospitals

scholarly journals Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

2017 ◽  
Vol 1 ◽  
pp. 1
Author(s):  
Tamer Fakhry ◽  
Mohamed Shawky
Keyword(s):  
Acute Appendicitis ◽  
Imaging Modality ◽  
Radiology Department ◽  
University Hospitals ◽  
Normal Appendix ◽  
Differential Leukocyte Count ◽  
Alvarado Score ◽  
Ultrasound Findings ◽  
Clinical Scoring ◽  
Us Findings

Appendicitis is the most common cause of emergency abdominal surgeries in children. Ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis. The Alvarado score is a 10-point scoring system for the diagnosis of appendicitis based on clinical data and differential leukocyte count. The aim of the present study was to evaluate a combination of clinical scoring (Alvarado score) and US findings for accurate diagnosis of appendicitis in children. The study was done in Menoufia University Hospitals from March 2011 to January 2013. 322 children with abdominal pain clinically suspected of having appendicitis were included in the study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for abdominal US. Among the 153 of the 322 patients who were operated on, 149 patients were diagnosed pre-operatively with acute appendicitis and 4 girls were diagnosed with complex ovarian cysts. Of the 149 patients diagnosed with appendicitis, the percentage of appendicitis was 93% (139/149) and 10 (7%) patients had normal appendix. The prevalence of appendicitis among the patients of the study was 43% (139/322). In conclusion, a combination of Alvarado scores and abdominal US is a good approach for the diagnosis of appendicitis in children to reduce the number of laparotomies for normal appendix. In the case of normal appendix or nonvisualization of the appendix via abdominal US without a high Alvarado score, appendicitis can be safely ruled out. If it is proven as an inflamed appendix on US or a high Alvarado score, patient should be subjected for appendectomy without delay.

Rapid Emergence of Daptomycin Resistance in Nonstriatum Corynebacterium Species: A Multicenter Study

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S32-S33
Author(s):  
Kaitlin Mitchell ◽  
Erin McElvania ◽  
Meghan Wallace ◽  
Amy Robertson ◽  
Lars Westblade ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Tertiary Care ◽  
Total N ◽  
Gradient Diffusion ◽  
Corynebacterium Species ◽  
Short Period ◽  
High Level ◽  
Level Resistance

Abstract Members of the genus Corynebacterium are increasingly recognized as causes of opportunistic infection; some species can be multidrug resistant, posing a treatment challenge. Daptomycin is frequently used as therapy of last resort in this setting, but previous work from our group demonstrated the ability of C striatum clinical isolates to rapidly develop high-level resistance to daptomycin, both in vivo and in vitro. Here, our objective was to expand this investigation into a multicenter study evaluating multiple Corynebacterium species. Corynebacterium strains from three tertiary-care academic medical centers (total, n = 76; site 1, n = 44; site 2, n = 15; site 3, n = 17) were evaluated, representing 16 species. Isolates were identified during routine clinical testing and reported to species level in accordance with each laboratory’s standard operating procedures. Identification of each species was confirmed using both VITEK MS and Bruker BioTyper MALDI-TOF MS. MICs to daptomycin (Etest), vancomycin (Etest), and telavancin (Liofilchem) at baseline were determined using gradient diffusion methods on Mueller-Hinton agar with blood (Hardy Diagnostics). Each isolate was then inoculated in duplicate to 5 mL Tryptic Soy Broth. A daptomycin Etest was submerged in one tube from each pair, and growth was observed after 24-hour incubation. If turbidity was observed in the tube with daptomycin, MICs for each of the 3 antimicrobials were reassessed. High-level daptomycin resistance emerged in 24 strains: C aurimucosum (1/1 isolate tested), C bovis (1/2), C jeikeium (2/11), C macginleyi (3/3), C resistens (1/1), C simulans (1/1), C striatum (14/14 isolates), and C ulcerans (1/1). The majority of these isolates had MIC values >256 µg/mL following exposure to daptomycin. Forty-eight other isolates remained susceptible to daptomycin: C afermentans (1/1), C amycolatum (19/20), C diphtheriae (1/1), C jeikeium (7/11), C kroppenstedtii (2/2), C propinquum (3/3), C pseudodiphtheriticum (6/6), C tuberculostearicum (0/6), and C urealyticum (0/3). Many of these isolates did not undergo MIC testing postdaptomycin exposure in broth due to complete lack of growth. Among those that did (n = 19), the median daptomycin MIC was 0.38 µg/mL (mean 0.42 µg/mL; range 0.023-1.0 µg/mL). One isolate of C bovis and two isolates of C jeikeium yielded variable susceptibility to daptomycin; a subset of resistant colonies grew adjacent to the gradient diffusion strip. Upon isolation and further MIC testing, these colonies maintained high-level resistance. In addition, one isolate of C amycolatum exhibited high-level daptomycin resistance (MIC >256 µg/mL) prior to in vitro exposure. All isolates in the cohort were susceptible to vancomycin and telavancin, both before and after daptomycin exposure. Our findings suggest that multiple Corynebacterium species can rapidly develop high-level daptomycin resistance after a short period of exposure to this antimicrobial. This finding has important clinical implications, especially in the treatment of invasive infections or infections of indwelling medical devices.

scholarly journals Predictors for remission after transsphenoidal surgery in acromegaly: a Dutch multicenter study

2021 ◽  
Author(s):  
Eva C Coopmans ◽  
Mark R Postma ◽  
Thalijn L C Wolters ◽  
Sebastiaan W F van Meyel ◽  
Romana Netea-Maier ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Transsphenoidal Surgery ◽  
Early Stage ◽  
Primary Treatment ◽  
Postoperative Treatment ◽  
Tumor Diameter ◽  
Total N ◽  
Maximum Tumor Diameter ◽  
Biochemical Remission

Abstract Context Transsphenoidal surgery (TSS) is the primary treatment of choice in acromegaly. It is important to identify patients in whom surgical cure is not attainable at an early stage, both to inform patients on expected treatment outcome and to select those who are more likely to need additional therapy. Objective To identify predictors for remission after TSS in acromegaly. Design Large multicenter study with retrospective data collection from three tertiary neurosurgical referral centers in the Netherlands. Methods We analyzed clinical data since 2000 from three cohorts (Groningen, Nijmegen and Rotterdam, total n=282). Multivariate regression models were used to identify predictors of early biochemical remission (12 weeks-1 year postoperatively) according to the 2010 consensus criteria, long-term remission (age- and sex normalized IGF-1 and the absence of postoperative treatment until last follow-up) and relative IGF-1 and GH reduction. Results A larger maximum tumor diameter (OR 0.91, 95% CI 0.87–0.96, p≤0.0001) was associated with a lower chance of early biochemical remission. A larger maximum tumor diameter (OR 0.93, 95% CI 0.89–0.97, p=0.0022) and a higher random GH concentration at diagnosis (OR 0.98, 95% CI 0.96–0.99, p=0.0053) were associated with a lower chance of long-term remission. Conclusion Maximum tumor diameter and random GH concentration at diagnosis are the best predictors for remission after TSS in acromegaly.

scholarly journals Measurement properties of the questionnaire “Mosaic of opinions on induced abortion”: a multicenter study in seven Brazilian hospitals

2018 ◽  
Vol 64 (12) ◽  
pp. 1091-1102
Author(s):  
Denis Barbosa Cacique ◽  
Renato Passini Junior ◽  
Maria José Martins Duarte Osis ◽  
Henrique Ceretta Oliveira ◽  
Kátia Melissa Padilha ◽  
...  
Keyword(s):  
Maternal Death ◽  
Multicenter Study ◽  
Healthcare Professionals ◽  
Induced Abortion ◽  
Factorial Analysis ◽  
Measurement Properties ◽  
University Hospitals ◽  
Multicenter Phase ◽  
Multi Center Study ◽  
Center Study

SUMMARY In Brasil, abortion is legal in cases of rape, when there is a risk of maternal death, and in cases of fetal anencephaly. However, the literature reports that some doctors refuse to care for women with such demands or come to perform it in a discriminatory manner. OBJECTIVE: Pretest, test and evaluate the measurement properties of the “Mosaic of Opinions on Induced Abortion,” a questionnaire developed to investigate the perspectives of Brazilian healthcare professionals about the morality of abortion. METHODS: Firstly, the questionnaire was pretested in an intentional sample of specialists. Secondly, it was tested in a randomized sample of 32 healthcare professionals. Finally, we conducted a multi-center study in seven university hospitals to evaluate the measurement properties of the questionnaire. RESULTS: Combined samples of the three phases totalized 430 individuals. In pretest and test, all the evaluated aspects obtained satisfactory results. In the multicenter phase, confirmatory factorial analysis led to an important reduction of the questionnaire, which also obtained good indicators of reliability, beyond the validation of construct and criteria. CONCLUSION: Questionnaire has been validated and is suitable for use in other surveys in Brasil.

Radiography and ultrasound of the equine neck

UK-Vet Equine ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 142-149
Author(s):  
Jonathon J Dixon ◽  
Lucy Meehan
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Ultrasound Examination ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Cross Sectional ◽  
Articular Process ◽  
Planar Images ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Diagnostic imaging of the equine neck is undertaken for a wide variety of conditions. In many cases, radiography is the principal imaging modality, often complemented by ultrasound examination. Common conditions encountered include osteoarthritis, articular process joint osteochondral fragmentation, cervical vertebral malformation (‘wobbler’), fractures and numerous soft tissue lesions. The complex three-dimensional anatomy of the region limits interpretation of planar images and, in some cases, cross-sectional imaging (such as computed tomography) may be required. However, careful use of radiography and ultrasound can help clinicians to achieve a diagnosis in many cases, often from combining conventional and lesion-orientated projections with a thorough clinical examination.

scholarly journals Management and outcome of recurrent adult craniopharyngiomas: an analysis of 42 cases with long-term follow-up

2016 ◽  
Vol 41 (6) ◽  
pp. E11 ◽  
Author(s):  
Mazda K. Turel ◽  
Georgios Tsermoulas ◽  
Lior Gonen ◽  
George Klironomos ◽  
Joao Paulo Almeida ◽  
...  
Keyword(s):  
Residual Disease ◽  
Total Duration ◽  
Additional Treatment ◽  
Response To Treatment ◽  
Karnofsky Performance Scale ◽  
Adjuvant Radiation ◽  
Total N ◽  
Repeat Treatment ◽  
Tertiary Center

OBJECTIVE The treatment of recurrent and residual craniopharyngiomas is challenging. In this study the authors describe their experience with these tumors and make recommendations on their management. METHODS The authors performed an observational study of adult patients (≥ 18 years) with recurrent or residual craniopharyngiomas that were managed at their tertiary center. Retrospective data were collected on demographics and clinical, imaging, and treatment characteristics from patients who had a minimum 2-year follow-up. Descriptive statistics were used and the data were analyzed. RESULTS There were 42 patients (27 male, 15 female) with a mean age of 46.3 ± 14.3 years. The average tumor size was 3.1 ± 1.1 cm. The average time to first recurrence was 3.6 ± 5.5 years (range 0.2–27 years). One in 5 patients (8/42) with residual/recurrent tumors did not require any active treatment. Of the 34 patients who underwent repeat treatment, 12 (35.3%) had surgery only (transcranial, endoscopic, or both), 9 (26.5%) underwent surgery followed by adjuvant radiation therapy (RT), and 13 (38.2%) received RT alone. Eighty-six percent (18/21) had a gross-total (n = 4) or near-total (n = 14) resection of the recurrent/residual tumors and had good local control at last follow-up. One of 5 patients (7/34) who underwent repeat treatment had further treatment for a second recurrence. The total duration of follow-up was 8.6 ± 7.1 years. The average Karnofsky Performance Scale score at last follow-up was 80 (range 40–90). There was 1 death. CONCLUSIONS Based on this experience and in the absence of guidelines, the authors recommend an individualized approach for the treatment of symptomatic or growing tumors. This study has shown that 1 in 5 patients does not require repeat treatment of their recurrent/residual disease and can be managed with a “scan and watch” approach. On the other hand, 1 in 5 patients who had repeat treatment for their recurrence in the form of surgery and/or radiation will require further additional treatment. More studies are needed to best characterize these patients and predict the natural history of this disease and response to treatment.

scholarly journals OP0180 DIAGNOSTIC VALIDITY OF ULTRASOUND INCLUDING EXTRA-CRANIAL ARTERIES IN GIANT CELL ARTERITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 112.2-112
Author(s):  
I. Monjo ◽  
E. Fernández ◽  
D. Peiteado ◽  
A. Balsa ◽  
E. De Miguel
Keyword(s):  
Positive Predictive Value ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Ultrasound Examination ◽  
Axillary Artery ◽  
Imaging Modality ◽  
Large Vessel ◽  
Research Support

Background:Giant cell arteritis (GCA) is a chronic vasculitis of the medium and large arteries. The involvement of large vessel (LV) either isolated or associated with cranial artery is frequent, so it is necessary to use imaging techniques for diagnosis, because the biopsy in these cases is not useful. European League Against Rheumatism (EULAR) recommends an early imaging test in patients with suspected GCA, and ultrasound of temporal±axillary arteries is recommended as the first imaging modality in patients with suspected predominantly cranial GCA (1).Objectives:To assess the validity of Colour Doppler ultrasound (CDUS) of temporal superficial arteries (TA) and LV (axillary, subclavian and carotid) in the diagnosis of GCA, using as gold standard the patient’s definitive clinical diagnosis. Analyse if routine ultrasound examination of LV improves the diagnostic accuracy.Methods:This was an observational, descriptive and analytical study of 198 consecutive patients with GCA suspicion. A baseline CDUS of the TA and LV was performed. Ultrasound diagnosis was made according to the OMERACT (Outcome Measures in Rheumatology) definitions of halo sign and was established as a limit of average intimal thickness ≥ 0.34 mm for superficial temporal arteries and ≥ 1 mm for axillary, subclavian and carotid arteries. Statistical analysis was performed using SPSS version 25.Results:Eighty-seven patients (43.9%) were CDUS compatible with GCA, and 111 patients (56.1%) had a negative CDUS. Among the patients with positive CDUS three different patterns were detected: 45 patients (51.7%) had an exclusive cranial involvement, 31 (35.6%) had a mixed pattern with involvement of both TA and LV and 11 (12.6%) had an exclusive LV involvement. The validity (sensitivity and specificity) and security (positive predictive value and negative predictive value) of diagnostic are shown in table.When we analyse patients with LV involvement, 87.8% have axillary artery involvement, 77.4% subclavian involvement and 34.4% carotids involvement. If we only explored the axillary arteries, 12.2% of patients with LV involvement would not be diagnosed. However, if we explored axillary and subclavian arteries, 100% of patients with LV involvement would be diagnosed.Conclusion:Half of the patients with GCA have LV involvement and up to 12.8% exclusively LV affectation in our series. Adding CDUS exploration of LV arteries to TA increases both sensitivity and diagnostic specificity. The minimum ultrasound examination of LV should include both axillary and subclavian arteries.References:[1]Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018;77(5):636–3SensitivitySpecificityPositive predictive valueNegative predictive valueCDUS TA and LV97,7%97,3%96,6%98,2%CDUS TA83,9%97,3%96,1%88,5%Disclosure of Interests:Irene Monjo: None declared, Elisa Fernández: None declared, Diana Peiteado: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi)

scholarly journals Testing telediagnostic right upper quadrant abdominal ultrasound in Peru: A new horizon in expanding access to imaging in rural and underserved areas

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255919
Author(s):  
Thomas J. Marini ◽  
Daniel C. Oppenheimer ◽  
Timothy M. Baran ◽  
Deborah J. Rubens ◽  
Ann Dozier ◽  
...  
Keyword(s):  
Image Quality ◽  
Ultrasound Examination ◽  
Imaging Modality ◽  
Standard Of Care ◽  
Abdominal Ultrasound ◽  
The United States ◽  
Sonographic Examination ◽  
Ultrasound Technique ◽  
Excellent Image Quality ◽  
Experienced Radiologist

Background Hepatic and biliary diseases are prevalent worldwide, but the majority of people lack access to diagnostic medical imaging for their assessment. The liver and gallbladder are readily amenable to sonographic examination, and ultrasound is a portable, cost-effective imaging modality suitable for use in rural and underserved areas. However, the deployment of ultrasound in these settings is limited by the lack of experienced sonographers to perform the exam. In this study, we tested an asynchronous telediagnostic system for right upper quadrant abdominal ultrasound examination operated by individuals without prior ultrasound experience to facilitate deployment of ultrasound to rural and underserved areas. Methods The teleultrasound system utilized in this study employs volume sweep imaging and a telemedicine app installed on a tablet which connects to an ultrasound machine. Volume sweep imaging is an ultrasound technique in which an individual scans the target region utilizing preset ultrasound sweeps demarcated by easily recognized external body landmarks. The sweeps are saved as video clips for later interpretation by an experienced radiologist. Teleultrasound scans from a Peruvian clinic obtained by individuals without prior ultrasound experience were sent to the United States for remote interpretation and quality assessment. Standard of care comparison was made to a same-day ultrasound examination performed by a radiologist. Results Individuals without prior ultrasound experience scanned 144 subjects. Image quality was rated “poor” on 36.8% of exams, “acceptable” on 38.9% of exams, and “excellent” on 24.3% of exams. Among telemedicine exams of “acceptable” or “excellent” image quality (n = 91), greater than 80% of the liver and gallbladder were visualized in the majority of cases. In this group, there was 95% agreement between standard of care and teleultrasound on whether an exam was normal or abnormal, with a Cohen’s kappa of 0.84 (95% CI 0.7–0.98, p <0.0001). Finally, among these teleultrasound exams of “acceptable” or “excellent” image quality, the sensitivity for cholelithiasis was 93% (95% CI 68.1%-99.8%), and the specificity was 97% (95% CI 89.5%-99.6%). Conclusion This asynchronous telediagnostic system allows individuals without prior ultrasound experience to effectively scan the liver, gallbladder, and right kidney with a high degree of agreement with standard of care ultrasound. This system can be deployed to improve access to diagnostic imaging in low-resource areas.

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