Restructuring of a Hospital Radiology Department: Subspecialization Between Man, Machine, and Multidisciplinary Board

Background Radiology, like almost no other discipline, is faced with a rapid increase in information and technology. This and the growing demands regarding referring medicine, quality requirements, and personnel efficiency increasingly require subspecialization in terms of content. There is already an established move towards radiological subspecialization in the Anglo-American region. In this review article, the content and possibilities of restructuring a hospital radiology department are presented in order to support acceptance in German-speaking countries. Method Based on the current literature, the aspects of subspecialized radiology as well as its necessity, advantages, and disadvantages are discussed and the challenges to hospital management with respect to strategic implementation in the individual phases are presented based on the example of a university radiology department. The viewpoints also take into account the education regulations and integrate a modern learning concept. Results and Conclusion Modern restructuring of hospital radiology departments is faced with increasing demands on a traditionally technically organized radiology department with regard to the complexity of referring medicine, subspecialization pressure (including in certified boards), and staff efficiency. The restructuring of a radiology department must be aligned with the clinical requirements and discussed in the overall concept of radiology including its environment. Key points: Citation Format

Thirty-Eight Years of ‘Wellbeing’ Research: Bibliometric Analysis of Open Access Documents.

The purpose of the study was to explore the theme ‘Wellbeing’ in open access documents from 1982 to 2020. Scopus database was used to conduct the bibliometric analysis of 9604 open access documents. VOSviewer software was used to analyse the research articles associated with ‘Wellbeing’ research. Search was limited to keywords of ‘Wellbeing’ and ‘Well-being’. Only articles of English language and open access from 1982 to the year 2020 was selected for the analysis. Results of bibliometric maps revealed that the United Kingdom was having the highest total link strength among all the countries globally. International Journal of Environmental Research and Public Health published by MDPI AG was at the top in publishing the open access documents pertaining to ‘Wellbeing’ search and the most prolific author was Bruera, Éduardo D. The highest number of open access publications were happened in the field of Medicine. Quality of life, health, mental health, depression, and physical activity were the major keywords that were associated with central theme ‘Wellbeing’. This study, to best of our knowledge, is the first of its kind in mapping the wellbeing in open access documents of Scopus. This will aid in future research directions for the researchers.

Generating adversarial images to monitor the training state of a CNN model

Deep neural networks have shown effectiveness in many applications, however, in regulated applications like automotive or medicine, quality guarantees are required. Thus, it is important to understand the robustness of the solutions to perturbations in the input space. In order to identify the vulnerability of a trained classification model and evaluate the effect of different perturbations in the input on the output class, two different methods to generate adversarial examples were implemented. The adversarial images created were developed into a robustness index to monitor the training state and safety of a convolutional neural network model. In the future work, some generated adversarial images will be included into the training phase to improve the model robustness.

Implementation of field detection devices for antimalarial quality screening in Lao PDR—A cost-effectiveness analysis

Substandard and falsified (SF) antimalarials have devastating consequences including increased morbidity, mortality and economic losses. Portable medicine quality screening devices are increasingly available, but whether their use for the detection of SF antimalarials is cost-effective is not known. We evaluated the cost-effectiveness of introducing such devices in post-market surveillance in pharmacies in Laos, conservatively focusing on their outcome in detecting SF artemisinin-based combination therapies (ACTs). We simulated the deployment of six portable screening devices: two handheld near-infrared [MicroPHAZIR RX, NIR-S-G1], two handheld Raman [Progeny, TruScan RM]; one portable mid-infrared [4500a FTIR] spectrometers, and single-use disposable paper analytical devices [PADs]. We considered two scenarios with high and low levels of SF ACTs. Different sampling strategies in which medicine inspectors would test 1, 2, or 3 sample(s) of each brand of ACT were evaluated. Costs of inspection including device procurement, inspector time, reagents, reference testing, and replacement with genuine ACTs were estimated. Outcomes were measured as disability adjusted life years (DALYs) and incremental cost-effectiveness ratios were estimated for each device compared with a baseline of visual inspections alone. In the scenario with high levels of SF ACTs, all devices were cost-effective with a 1-sample strategy. In the scenario of low levels of SF ACTs, only four devices (MicroPHAZIR RX, 4500a FTIR, NIR-S-G1, and PADs) were cost-effective with a 1-sample strategy. In the multi-way comparative analysis, in both scenarios the NIR-S-G1 testing 2 samples was the most cost-effective option. Routine inspection of ACT quality using portable screening devices is likely to be cost-effective in the Laos context. This work should encourage policy-makers or regulators to further investigate investment in portable screening devices to detect SF medicines and reduce their associated undesired health and economic burdens.

A comparative field evaluation of six medicine quality screening devices in Laos

Background Medicine quality screening devices hold great promise for post-market surveillance (PMS). However, there is little independent evidence on their field utility and usability to inform policy decisions. This pilot study in the Lao PDR tested six devices’ utility and usability in detecting substandard and falsified (SF) medicines. Methodology/principal findings Observational time and motion studies of the inspections by 16 Lao medicine inspectors of 1) the stock of an Evaluation Pharmacy (EP), constructed to resemble a Lao pharmacy, and 2) a sample set of medicines (SSM); were conducted without and with six devices: four handheld spectrometers (two near infrared: MicroPHAZIR RX, NIR-S-G1 & two Raman: Progeny, Truscan RM); one portable mid-infrared spectrometer (4500a), and single-use paper analytical devices (PAD). User experiences were documented by interviews and focus group discussions. Significantly more samples were wrongly categorised as pass/fail with the PAD compared to the other devices in EP inspections (p<0.05). The numbers of samples wrongly classified in EP inspections were significantly lower than in initial visual inspections without devices for 3/6 devices (NIR-S-G1, MicroPHAZIR RX, 4500a). The NIR-S-G1 had the fastest testing time per sample (median 93.5 sec, p<0.001). The time spent on EP visual inspection was significantly shorter when using a device than for inspections without devices, except with the 4500a, risking missing visual clues of samples being SF. The main user errors were the selection of wrong spectrometer reference libraries and wrong user interpretation of PAD results. Limitations included repeated inspections of the EP by the same inspectors with different devices and the small sample size of SF medicines. Conclusions/significance This pilot study suggests policy makers wishing to implement portable screening devices in PMS should be aware that overconfidence in devices may cause harm by reducing inspectors’ investment in visual inspection. It also provides insight into the advantages/limitations of diverse screening devices in the hands of end-users.

Development of Population-Based Cancer Indicators and a Measurement of Cancer Care Continuum Using a Modified Delphi Method

To identify population-based cancer indicators and construct monitoring systems for the entire lifecycle of cancer patients using a modified Delphi method. A modified Delphi method was used to identify the cancer indicators and measurement by scoping review and gray literature. The final list of cancer indicators was developed by consensus of 11 multidisciplinary experts over multiple rounds and rating scored the importance of each indicator on a 10-point scale. Frequency analysis was performed to rate with median scores ≥7 and finalized the list of indicators according to the priority. Initially, 254 indicators were identified, of which 94 were considered important and feasible. After two rounds of rating by the experts and panel discussions, 26 indicators were finalized in six domains: primary prevention (n = 7), secondary prevention (n = 11), treatment (n = 2), quality of life (n = 4), survivor management (n = 1), and end-of-life care (n = 1). The Donabedian model used for examining health services and the Institute of Medicine quality of healthcare domains were applied to the measurement system. Panel experts identified cancer indicators based on priorities with a high level of consensus, providing a scrupulous foundation for community-based monitoring of cancer patients.

Challenges in maintaining medicine quality while aiming for universal health coverage: a qualitative analysis from Indonesia

IntroductionIndonesia, the world’s fourth most populous nation, is close to achieving universal health coverage (UHC). A widely-publicised falsified vaccine case in 2016, coupled with a significant financial deficit in the national insurance system, has contributed to concern that the rapid scale-up of UHC might undermine medicine quality. We investigated the political and economic factors that drive production and trade of poor-quality medicines in Indonesia.MethodsWe reviewed academic publications, government regulations, technical agency documents and news reports to develop a semi-structured questionnaire. We interviewed healthcare providers, policy-makers, medicine regulators, pharmaceutical manufacturers, patients and academics (n=31). We included those with in-depth knowledge about the falsified vaccine case or the pharmaceutical business, medicine regulation, prescribing practice and the implementation of UHC. We coded data using NVivo software and analysed by constant comparative method.ResultsThe scale-up of UHC has cut revenues for physicians and pharmaceutical manufacturers. In the vaccine case, free, quality-assured vaccines were available but some physicians, seeking extra revenue, promoted expensive alternatives. Taking advantage of poor governance in private hospitals, they purchased cut-price ‘vaccines’ from freelance salespeople.A single-winner public procurement system which does not explicitly consider quality has slashed the price paid for covered medicines. Trade, industrial and religious policies simultaneously increased production costs, pressuring profit margins for manufacturers and distributors. They reacted by cutting costs (potentially threatening quality) or by market withdrawal (leading to shortages which provide a market for falsifiers). Shortages and physician-promoted irrational demand push patients to buy medicines in unregulated channels, increasing exposure to falsified medicines.ConclusionMarket factors, including political pressure to reduce medicine prices and healthcare provider incentives, can drive markets for substandard and falsified medicines. To protect progress towards UHC, policy-makers must consider the potential impact on medicine quality when formulating rules governing health financing, procurement, taxation and industry.