Determining the Patient Complexity of Head CT Examinations: Implications for Proper Valuation of a Critical Imaging Service

We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.

Download Full-text

Development and validation of a Japanese version of the Patient Centred Assessment Method and its user guide: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-037282 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037282

Author(s):

Rieko Mutai ◽

Yoshifumi Sugiyama ◽

Shuhei Yoshida ◽

Ryoko Horiguchi ◽

Takamasa Watanabe ◽

...

Keyword(s):

Primary Care ◽

Factor Analysis ◽

Japanese Version ◽

Well Being ◽

Cross Sectional Study ◽

Assessment Method ◽

Sectional Study ◽

Cross Sectional ◽

Vas Scores ◽

Patient Complexity

ObjectivesThe primary objective of this study was to develop the Japanese version of the Patient Centred Assessment Method (PCAM) and its user guide. The secondary objective was to examine the validity and reliability in the primary care setting.DesignCross-sectional study.SettingThree family physician teaching clinics located in urban residential areas in Tokyo, Japan.ParticipantsPatients who were aged 20 years or older, and who had an appointment with physicians at the three participating clinics.Main outcome measuresPatient complexity measured by PCAM and complexity/burden level measured by a Visual Analogue Scale (VAS).ResultsAlthough confirmatory factor analysis using a model described in a previous study revealed that the indices did not meet the criteria for good fit, exploratory factor analysis revealed a new three-factor structure of ‘Personal well-being,’ ‘Social interaction’ and ‘Needs for care/service.’ Cronbach’s alpha of PCAM was 0.86. Spearman’s rank correlation coefficients between PCAM scores and VAS scores were 0.51 for complexity (p<0.001) and 0.41 for burden (p<0.001). There were 42 patients (14.3% of total patients) with PCAM scores greater than its mean of 16.5 but with complexity VAS scores less than its mean of 20.8.ConclusionsThe Japanese version of PCAM and its user guide were developed through Japanese translation and cultural adaptation by cognitive debriefing. PCAM is a valid and reliable tool to assess patient complexity in the primary care settings in Japan. Additionally, although the correlation between total PCAM scores and complexity/burden as assessed by VAS was moderate, PCAM can more precisely identify patient complexity than skilled physician’s intuition.

Download Full-text

Enhancing Ant-Based Algorithms for Medical Image Edge Detection by Admissible Perturbations of Demicontractive Mappings

Symmetry ◽

10.3390/sym13050885 ◽

2021 ◽

Vol 13 (5) ◽

pp. 885

Author(s):

Vasile Berinde ◽

Cristina Ţicală

Keyword(s):

Edge Detection ◽

Medical Image ◽

Test Functions ◽

Head Ct ◽

X Ray ◽

Numerical Tests ◽

Image Edge Detection ◽

Evaluation Of Parameters ◽

Image Edge ◽

Demicontractive Mappings

The aim of this paper is to show analytically and empirically how ant-based algorithms for medical image edge detection can be enhanced by using an admissible perturbation of demicontractive operators. We thus complement the results reported in a recent paper by the second author and her collaborators, where they used admissible perturbations of demicontractive mappings as test functions. To illustrate this fact, we first consider some typical properties of demicontractive mappings and of their admissible perturbations and then present some appropriate numerical tests to illustrate the improvement brought by the admissible perturbations of demicontractive mappings when they are taken as test functions in ant-based algorithms for medical image edge detection. The edge detection process reported in our study considers both symmetric (Head CT and Brain CT) and asymmetric (Hand X-ray) medical images. The performance of the algorithm was tested visually with various images and empirically with evaluation of parameters.

Download Full-text

Pattern of Emergent Head Computed Tomography Findings in a Tertiary Care Hospital during off Working Hours: Retrospective Analysis

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_362_18 ◽

2019 ◽

Vol 10 (02) ◽

pp. 207-211

Author(s):

Rajneesh K. Patel ◽

Amit Kumar Choubey ◽

Brijesh K. Soni ◽

Rajeev Sivasankar ◽

Vikash Chauhan

Keyword(s):

Computed Tomography ◽

Health Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Working Hours ◽

Care Hospital ◽

Head Ct ◽

Total Head ◽

Ct Head ◽

Head Computed Tomography

ABSTRACT Introduction: Emergency head computed tomography (CT) is rising exponentially during off working hours due to evidence-based medicine, patient’s expectation and desires, easy availability and apprehension of medico-legal cases, thereby raising health-care cost. There is huge gap in demand and supply of radiologist, especially during off working hours. There is need to know the pattern of emergency head findings. Materials and Methods: A retrospective analysis of all emergent noncontrast CT head during off working hours in the Department of Radiodiagnosis of a Tertiary Care Hospital, Mumbai, India, which were performed from June 2017 to May 2018. CT findings of 308 patients were analyzed. Results: About 63.6% of total head CT showed no significant abnormality. The most common abnormality was intracranial hemorrhage which was just 9.1% followed by acute infarct which was 6.2%. Extradural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage was only 1% each of total head CT findings. No significant abnormality was detected in 74.65%, 70.21%, 89.13%, 31.37%, 100%, and 69.09% in cases of head injury, seizure, giddiness/dizziness/syncope, cerebrovascular accident, transient ischemic attack, and altered sensorium, respectively. Conclusion: Pattern analysis of emergent head CT reveals that most of the emergent CT head shows no significant abnormality. There is a need for stringent guidelines for emergent head CT, training of emergency physician as well as CT technician for common findings to bridge the radiologist demand-supply gap for providing effective health care in peripheral hospitals.

Download Full-text