Overnight radiology resident discrepancies at a large pediatric hospital: categorization by year of training, program, imaging modality, and report type

2021 ◽  
pp. 028418512098157
Author(s):  
Mary L Dinh ◽  
Rana Yazdani ◽  
Nikhil Godiyal ◽  
Cory M Pfeifer
Keyword(s):  
Pediatric Radiology ◽  
Imaging Modality ◽  
Pediatric Hospital ◽  
Community Based ◽  
Radiology Resident ◽  
Radiology Report ◽  
Hospital System ◽  
Faculty Assessment ◽  
Significant Difference ◽  
Major Discrepancy

Background Overnight radiology resident discrepancies have been described in multiple studies; however, study of resident discrepancies specific to pediatric radiology is limited. Purpose To examine radiology resident discrepancies as they pertain to a large pediatric hospital system. Material and Methods A total of 21,560 preliminary reports issued by 39 residents over a one-year period were scored as agreement, minor discrepancy, or major discrepancy by faculty members using a modification of the 2009 RADPEER scoring system. Residents were trainees of three different diagnostic radiology programs: large university-based, medium-sized community-based, or small community-based. Discrepancy rates were evaluated based on resident postgraduate year, program, and imaging modality. The effect of a general pediatric radiology report versus pediatric neuroradiology report of a CT scan was also tested. CT was the only modality in which there were comparable numbers of studies scored by both general pediatric radiologists and neuroradiologists. Results The rate of major resident to faculty assessment discrepancies was 1.01%, and the rate of minor resident to faculty assessment discrepancies was 4.47%. Major discrepancy rates by postgraduate years 3-5 were 1.08%, 0.75%, and 1.59%, respectively. Major discrepancy rates were highest for MR (11.22%), followed by CT (1.82%), radiographs (0.91%), and ultrasound (0.56%). There was no significant difference in discrepancy rate between residency programs and general pediatric radiology report of a CT versus pediatric neuroradiology report of a CT. Conclusion Radiology discrepancy rates for residents issuing preliminary reports at a large children’s hospital system are similar to those reported for adult procedures.

scholarly journals Community Pediatric Hospitalist Workload: Results from a National Survey

2019 ◽  
Vol 14 (11) ◽  
pp. 682-685 ◽  
Author(s):  
Francisco Alvarez ◽  
Corrie E McDaniel ◽  
Krista Birnie ◽  
Craig Gosdin ◽  
Allison Mariani ◽  
...  
Keyword(s):  
Program Development ◽  
National Survey ◽  
Hospital Medicine ◽  
Full Time ◽  
Clinical Services ◽  
Pediatric Hospital ◽  
Community Based ◽  
Future Studies ◽  
Significant Difference ◽  
Community Site

As a newly recognized subspecialty, understanding programmatic models for pediatric hospital medicine (PHM) programs is vital to lay the groundwork for a sustainable field. Although variability has been described within university-based PHM programs, there remains no national benchmark for community-based PHM programs. In this report, we describe the workload, clinical services, employment, and perception of sustainability of 70 community-based PHM programs in 29 states through a survey of community site leaders. The median hours for a full-time hospitalist was 1,882 hours/year with those employed by community hospitals working 8% more hours/year and viewing appropriate morning pediatric census as 20% higher than those employed by university institutions. Forty-three out of 70 (63%) site leaders perceived their programs as sustainable, with no significant difference by employer structure. Future studies should further explore root causes for workload discrepancies between community and academic employed programs along with establishing potential standards for PHM program development.

#74: Development of a Solid-Organ Transplant-Specific Antibiogram in a Tertiary Pediatric Hospital in Canada

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S1-S1
Author(s):  
T Kitano ◽  
M Science ◽  
N Nalli ◽  
K Timberlake ◽  
U Allen ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Lower Sensitivity ◽  
Solid Organ ◽  
Pediatric Hospital ◽  
Post Transplant ◽  
Significant Difference ◽  
Organ Specific ◽  
Wide Population

Abstract Background Solid-organ transplant (SOT) patients are more vulnerable to infections by antimicrobial-resistant organisms (AROs) because of their hospital exposure, compromised immune systems, and antimicrobial exposure. Therefore, it may be useful for transplant facilities to create transplant-specific antibiograms to direct empirical antimicrobial regimens and monitor trends in antimicrobial resistance. Methods SOT (i.e., lung, liver, renal, and heart) antibiograms were created using antimicrobial susceptibility data on isolates from 2012 to 2018 at The Hospital for Sick Children, a tertiary pediatric hospital and transplant center in Toronto, Ontario. The Clinical Laboratory Standards Institute (CLSI) guidelines were followed to generate the antibiograms. The first clinical isolate of a species from a patient in each year was included irrespective of body site; duplicates were eliminated and surveillance cultures were excluded. Results from 2 years of data were pooled on a rolling basis to achieve an adequate sample size in both SOT and hospital-wide antibiogram. The SOT antibiogram was then compared with the hospital-wide antibiogram of the compatible 2 pooled years from 2012 to 2018. For subgroup analyses in the SOT population, organ-specific antibiograms and transplant timing-specific antibiograms (pretransplant, post-transplant <1 year, and post-transplant ≥1 year) between transplant and sample collection dates were analyzed. All proportions were compared using the χ 2 test. Results The top 5 organisms in one (2 year) analysis period of the SOT antibiogram were Escherichia coli (n = 29), Staphylococcus aureus (n = 28), Pseudomonas aeruginosa (n = 20), Enterobacter cloacae complex (n = 18), and Klebsiella pneumoniae (n = 17). For E.coli, susceptibility in the SOT antibiogram was significantly lower than those in the hospital-wide antibiogram in 2017/2018 for ampicillin (27% vs. 48%; P = 0.015), piperacillin/tazobactam (55% vs. 87%; P < 0.001), cefotaxime (59% vs. 88%; P < 0.001), ciprofloxacin (71% vs. 87%; P = 0.007) and cotrimoxazole (41% vs. 69%; P < 0.001), but not significantly different for gentamicin (94% vs. 91%; P = 0.490), tobramycin (88% vs. 90%; P = 0.701) and amikacin (100% vs. 99%; P = 0.558). These findings were consistent throughout the study period in E.coli. There was no statistically significant difference between the SOT and hospital-wide antibiograms for other organisms. There were no significant differences in susceptibility between organ-specific antibiograms or transplant timing-specific antibiograms in 2012–2018. Conclusions We found that E.coli from the SOT population had a significantly lower sensitivity to all antimicrobials, except aminoglycosides, compared with those from the hospital-wide population. Other organisms had similar susceptibility to the hospital-wide population. Developing a SOT antibiogram will assist in revising and improving empiric treatment guidelines for this population.

The Effects of Production Performance Model and Competitive Environment of Hospital Systems

2013 ◽  
Vol 300-301 ◽  
pp. 1623-1627
Author(s):  
Ching Kuo Wei
Keyword(s):  
Performance Model ◽  
Production Performance ◽  
Competitive Environment ◽  
Data Envelopment ◽  
Hospital System ◽  
Department Of Health ◽  
Competitive Environments ◽  
Significant Difference ◽  
Efficiency Performance ◽  
Hospital Systems

This study investigated the efficiency performance of the production technology of the Department of Health (DOH)-affiliated hospital system in Taiwan in different competitive environments. This study used Data Envelopment Analysis (DEA) to analyze a total of 396 hospitals of different systems in Taiwan. The results indicated that, in terms of the internal competitive environment, the production performance of hospital Q was the best, while that of hospital N was the worst. This study also analyzed the production performance and scale of DOH-affiliated hospitals and provided hospitals with a direction for scale development. Finally, this study proposed suggestions on improvement direction for hospitals with poor production performance. As for external competitive environment, there is no significant difference in the average efficiency among various hospital systems. However, there are a lot to be improved in DOH-affiliated hospitals, especially in the aspect of technology efficiency. The improvement of technology efficiency should be more beneficial to the overall efficiency.

scholarly journals Clinico-radiological profile of abdominal tuberculosis in HIV/AIDS patients-a study from rural central India

2017 ◽  
Vol 5 (5) ◽  
pp. 1980 ◽  
Author(s):  
Nisar A. Wafai ◽  
Sudhir K. Yadav ◽  
Prem S. Singh ◽  
Manoj Kumar ◽  
Prafulla K. Singh ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Central India ◽  
Abdominal Tuberculosis ◽  
Cd4 Count ◽  
Common Finding ◽  
Non Invasive ◽  
Significant Difference ◽  
Average Size ◽  
Loss Of Appetite ◽  
Hiv Aids

Background: One of the major challenge of present era is dual epidemic of HIV/AIDS and tuberculosis. With immunosuppression, risk of opportunistic diseases increases in these patients and tuberculosis is most common opportunistic infection. The prevalence of abdominal tuberculosis seems to be rising, particularly due to increasing prevalence of HIV infection. The diagnosis of abdominal tuberculosis can often be difficult and it remains underdiagnosed, in view of its nonspecific manifestations. The investigations involved in its diagnosis are expensive and time consuming, however, ultrasonography (USG) is an affordable, non-invasive and widely available modality which can be of help in the diagnosis of abdominal tuberculosis. Therefore, this study was undertaken to evaluate clinical and USG finding among Abdominal Tuberculosis patients with HIV/AIDS.Methods: After informed consent, patients underwent thorough history taking and clinical examination followed by high quality USG abdomen and other biochemical and haematological tests including CD4 count. Follow up USG abdomen was done at time of completion of course of ATT and data was analysed.Results: 45 were found to have abdominal tuberculosis. Of these patients, 31(68.9%) were male and 14 (31.1%) were female. Mean age of HIV-abdominal TB was 34.27±9.66 years. most common symptoms were weight loss 41(91.1%), loss of appetite 38(84.4%), fever       32(71.1%), generalized weakness 30(66.7%) and abdominal pain 27(60.0%). On USG abdomen, intraabdominal lymphadenopathy was most common finding found in 44(97.8%). Average size of enlarged lymph node was 3.1+-1.0 cm. Mesenteric lymphnodes were enlarge in 40(88.89%), paraaortic 8(17.78%), retroperitoneal 4(8.89%) while peripancreatic and porta hepatic in 3(6.67%). splenomegaly was noted in 14(31.1%) cases. Hepatomegaly was found in 6 cases, who all were male. Ascites was evident in 5(11.1%) patients. Extensive involvement, defined as involvement of two or more intraabdominal sites, was found 24(53.3%) cases. There was no statistically significant difference found among these USG findings and CD4 count.Conclusions: The findings of lymphadenopathy (size>15mm) and hypoechoic/necrotic echotexture, hepatosplenomegaly with hypoechoic lesions in ultrasonography are suggestive of abdominal tuberculosis in HIV infected patients with unexplained nonspecific symptoms and low CD4 count.  However, above findings are not standardized and inability to confirm the diagnosis of tuberculosis by direct microscopy and culture is the limitation of this study. Ultrasonography is an affordable, widely available, non-invasive imaging modality which may be optimally utilized for the diagnosis of abdominal tuberculosis in HIV infected patients, especially in the rural setup where microbiological and other sophisticated radiological investigations have limited availability.

scholarly journals Agreement of Magnetic Resonance Imaging With Computed Tomography in the Assessment for Acute Skull Fractures in a Canine and Feline Cadaver Model

2021 ◽  
Vol 8 ◽  
Author(s):  
Silke Hecht ◽  
Kimberly M. Anderson ◽  
Aude Castel ◽  
John F. Griffin ◽  
Adrien-Maxence Hespel ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Head Trauma ◽  
Imaging Modality ◽  
Small Animal ◽  
Skull Fractures ◽  
Resonance Imaging ◽  
Significant Difference ◽  
Mri Sequences

Computed tomography (CT) is the imaging modality of choice to evaluate patients with acute head trauma. However, magnetic resonance imaging (MRI) may be chosen in select cases. The objectives of this study were to evaluate the agreement of MRI with CT in the assessment for presence or absence of acute skull fractures in a canine and feline cadaver model, compare seven different MRI sequences (T1-W, T2-W, T2-FLAIR, PD-W, T2*-W, “SPACE” and “VIBE”), and determine agreement of four different MRI readers with CT data. Pre- and post-trauma CT and MRI studies were performed on 10 canine and 10 feline cadaver heads. Agreement of MRI with CT as to presence or absence of a fracture was determined for 26 individual osseous structures and four anatomic regions (cranium, face, skull base, temporomandibular joint). Overall, there was 93.5% agreement in assessing a fracture as present or absent between MRI and CT, with a significant difference between the pre and post trauma studies (99.4 vs. 87.6%; p < 0.0001; OR 0.042; 95% CI 0.034–0.052). There was no significant difference between dogs and cats. The agreement for the different MRI sequences with CT ranged from 92.6% (T2*-W) to 94.4% (PD-W). There was higher agreement of MRI with CT in the evaluation for fractures of the face than other anatomic regions. Agreement with CT for individual MRI readers ranged from 92.6 to 94.7%. A PD-W sequence should be added to the MR protocol when evaluating the small animal head trauma patient.

scholarly journals Comparison of short-wavelength blue-light autofluorescence and conventional blue-light autofluorescence in geographic atrophy

2018 ◽  
Vol 103 (5) ◽  
pp. 610-616 ◽  
Author(s):  
Enrico Borrelli ◽  
Muneeswar Gupta Nittala ◽  
Nizar Saleh Abdelfattah ◽  
Jianqin Lei ◽  
Amir H Hariri ◽  
...  
Keyword(s):  
Blue Light ◽  
Imaging Modality ◽  
Fundus Autofluorescence ◽  
Intraclass Correlation ◽  
Geographic Atrophy ◽  
Area Measurement ◽  
Excitation Wavelength ◽  
Lesion Area ◽  
Significant Difference ◽  
The Individual

Background/aimsTo systematically compare the intermodality and inter-reader agreement for two blue-light confocal fundus autofluorescence (FAF) systems.MethodsThirty eyes (21 patients) with a diagnosis of geographic atrophy (GA) were enrolled. Eyes were imaged using two confocal blue-light FAF devices: (1) Spectralis device with a 488 nm excitation wavelength (488-FAF); (2) EIDON device with 450 nm excitation wavelength and the capability for ‘colour’ FAF imaging including both the individual red and green components of the emission spectrum. Furthermore, a third imaging modality (450-RF image) isolating and highlighting the red emission fluorescence component (REFC) was obtained and graded. Each image was graded by two readers to assess inter-reader variability and a single image for each modality was used to assess the intermodality variability.ResultsThe 95% coefficient of repeatability (1.35 mm2 for the 488-FAF-based grading, 8.13 mm2 for the 450-FAF-based grading and 1.08 mm2 for the 450-RF-based grading), the coefficient of variation (1.11 for 488-FAF, 2.05 for 450-FAF, 0.92 for 450-RF) and the intraclass correlation coefficient (0.994 for 488-FAF, 0.711 for 450-FAF, 0.997 for 450-RF) indicated that 450-FAF-based and 450-RF-based grading have the lowest and highest inter-reader agreements, respectively. The GA area was larger for 488-FAF images (median (IQR) 2.1 mm2 (0.8–6.4 mm2)) than for 450-FAF images (median (IQR) 1.0 mm2 (0.3–4.3 mm2); p<0.0001). There was no significant difference in lesion area measurement between 488-FAF-based and 450-RF-based grading (median (IQR) 2.6 mm2 (0.8–6.8 mm2); p=1.0).ConclusionThe isolation of the REFC from the 450-FAF images allowed for a reproducible quantification of GA. This assessment had good comparability with that obtained with 488-FAF images.

The Effects of the Amount of Fluid Used in Epiduroscopic Laser Neural Discectomy Procedures on Intraocular Pressure and an Evaluation of the Ocular Findings

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1357-1361
Author(s):  
Serbülent Gökhan Beyaz ◽  
Ali Metin Ülgen ◽  
Burçin Çakir
Keyword(s):  
Intraocular Pressure ◽  
Macular Thickness ◽  
Optic Disk ◽  
Increased Intracranial Pressure ◽  
Epidural Pressure ◽  
Fiber Layer ◽  
Hospital System ◽  
Rnfl Thickness ◽  
Ocular Findings ◽  
Significant Difference

Abstract Introduction During epiduroscopic laser neural discectomy (ELNP) procedures, the amount of fluid used in the epidural area may cause increased intracranial pressure. This study aimed to investigate the effect of increased epidural pressure on intraocular pressure and other ocular findings due to the amount of fluid delivered to the epidural area and the rate of delivery of the fluid. Material and Methods After obtaining approval from the Ethics Committee of Sakarya University Faculty of Medicine, patients who underwent ELNP in the Department of Anesthesiology and Reanimation Department, Algology Clinic, between January 2017 and May 2017 were included in this retrospective study. To evaluate the ocular findings after the operation, measurements obtained using an optical coherence tomography device were retrieved from the patient files and evaluated. Results Data from the medical files of 52 patients from the hospital system were evaluated. There was no significant difference between preoperative and postoperative retinal nerve fiber layer (RNFL) thickness, mean central macular thickness, optic disk area, and vertical cup-to-disk ratio (P &gt; 0.05). Conclusions Epiduroscopy procedures include intermittent or continuous infusion of saline into the epidural area. Currently, the volume of fluid that should be given to the epidural area in epiduroscopy procedures is very controversial. As a result of this study, we concluded that the amount of fluid used during ELNP, at 107.25 mL and 8.33 mL/min, had no effect on the intraocular pressure, optic disk diameter, macular thickness, or peripapillary RNFL thickness; thus, it was safe for ELNP.

Pencils and Pens: An Under-Recognized Source of Penetrating Injuries in Children

2011 ◽  
Vol 77 (8) ◽  
pp. 1076-1080
Author(s):  
Sarah B. Fisher ◽  
Matthew S. Clifton ◽  
Amina M. Bhatia
Keyword(s):  
Trauma Registry ◽  
Recent Literature ◽  
Surgical Intervention ◽  
Case Reports ◽  
Penetrating Trauma ◽  
Pediatric Hospital ◽  
Penetrating Injuries ◽  
Hospital System ◽  
Potential Risks ◽  
Home And School

Unlike other sharp objects, pens and pencils are readily available to children both at home and school. Although case reports are published, no series of pen or pencil injuries have been reported in the recent literature. We therefore reviewed the incidence and injury profiles of writing instruments as compared with other sources of penetrating trauma. The trauma registry from a large urban pediatric hospital system was queried for nonmissile, nonbite penetrating injuries from 2005 through 2009. Retrospective data was collected on demographics, injuries, operations, admissions, and mortalities. Additionally, data regarding pen and pencil injuries from 2009 to 2010 were collected prospectively, and one case from 2003 was included retrospectively. Fourteen injuries from writing instruments were seen and involved the head and neck (9), chest (1), bladder/perineum (2), and extremities (2). Eleven children were admitted and eight required surgical intervention. One child died from a transhemispheric brain injury after intraorbital penetration by a pencil. Penetrating trauma from writing instruments is not an uncommon source of injury and often requires surgical intervention to remove the object. Injuries from pens and pencils can be severe or even fatal. Appropriate parent and teacher education regarding the potential risks may help to prevent such injuries.

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