Diagnostic Department Research Articles

Assessing the Impact of Laboratory Information System on Clinical Workflow and Patient Outcomes

This study looks at how Valenzuela Medical Center's (VMC) clinical workflow efficiency and patient outcomes are influenced by the installa-tion of a Laboratory Information System (LIS). Due to time constraints, convenience sampling was used to collect data from sixty-three (63) medical professionals in the clinical and diagnostic laboratory depart-ments using a descriptive study design and a mixed-methods technique. To measure participant responses, descriptive statistics such as means, standard deviations, and frequency distributions were used. Using paired sample t-tests, inferential analysis was carried out to compare metrics before and after LIS adoption, with an emphasis on factors like error rates, turnaround times, and specimen handling accuracy.Key findings showed that LIS adoption improved data accessibility across departments, lowered transcription errors by about 28%, and cut specimen processing turnaround times by an average of 35%, all of which contributed to improved interdepartmental communication. Further-more, 90% of respondents expressed more confidence in the accuracy of laboratory results following LIS integration, and 85% of respondents re-ported higher satisfaction with data processing procedures. Significant improvements were also shown in patient outcomes, with quicker diag-nostic processing leading to earlier treatment commencement and, in some situations, shorter hospital stays overall. In addition to demon-strating the wider advantages of incorporating cutting-edge information systems in healthcare settings, this study emphasizes the critical role that LIS plays in improving laboratory operations, cutting down on diag-nostic delays, and improving the quality of patient care at VMC.

The “insider” ethnographic diagnostic radiographer thinking like “an outsider”

PurposeThe purpose of this paper is to explore how the ethnographic researcher navigates their insider–outsider status and provides a methodological contribution to this important aspect of ethnographic research; this will be framed from the researcher’s perspective using a semi-autoethnographic approach. The ethnographic study being reflected upon explored the culture in a Diagnostic Imaging Department (DID), looking at how radiographers work and what the issues were within their working environment. The original study was carried out within one DID in a District General Hospital in the East of England (Strudwick, 2011).Design/methodology/approachIn the original study, the researcher used ethnography to study the culture in a DID. Observation was carried out for a four-month period. Field notes were recorded and used to formulate topics for the interviews that were to follow. After the observation, the researcher conducted semi-structured interviews with key informants from the DID. Ten key informants were purposefully sampled from the DID to provide a cross-section of opinion from the staff. The data collected were analysed to identify key themes. This paper reflects on the data from the original study to explore the tensions between the insider and outsider researcher role and how this contributes to the way the ethnographic researcher views the environment, reports on their findings and how they feel about the data from their own perspective.FindingsEthnographers carrying out research in their own area of practice need to try to think like an outsider in order to see the environment with a sense of strangeness but also try to make sense of what the participants are thinking and doing. There is a tension between becoming part of the group in order to understand it and looking at the environment as an outsider in order to make a note of what is happening. Findings from the original ethnographic study will be used to illustrate this point and will be used to reflect on the feelings of the researcher, considering her insider and outsider status.Research limitations/implicationsThis study was carried out in one diagnostic imaging department in the east of England.Originality/valueThe author, who is a diagnostic radiographer and radiography educator reflects on how she managed the insider–outsider tension during her ethnographic observation and after the event when reflecting on the data from the original study.

Evaluation of the Safety Rate in the Diagnostic Radiology Departments in Alkhoms City, Libya

Diagnostic radiation such as X-rays and CT scans play a central role in the diagnosis of diseases. Excessive radiation exposure poses a high risk for healthcare providers as well as patients, which may cause serious diseases such as cancer. Providing protection requirements in the radiation departments and continuous inspection to prevent radiation leakage is the right way to provide human protection. The current study aimed to evaluate the safety rate in the diagnostic radiology departments in Alkhoms City. The questionnaire designed for the study in Arabic language, presented to experts for verification and review, then distributed to eleven medical centres in the Alkhoms region containing many relevant questions regarding the radiology department such as the name and address of a medical centre, in-formation about users and safety. Lead plates are present in 91% of health centres 36% of health centres installed lead plates for 1-5 years, 27% for 6-10 years, and 36% for 21 years or more. Lead plates are inspected once in 27%, three times in 9%, and four times or more in 9% of medical centres, on the other hand, 56% of medical centres didn’t inspect lead plates since installed. The lead plates last examined in 27% of medical centres a year ago, in 9% examined less than five years ago, and in 9% examined less than twenty years ago. On the other hand, 56% of medical centres have not performed any check-ups since installation. Protection glass and lead plates are present in 82% of medical centres, a radiation protection gown is present in 36%, and a dosimeter is present in 9% of medical centres only. Only 18% of health centres have organised a training programme for their radiology department staff. The safety rate in radiology departments in Alkhoms City- Libya is low because most medical centres lack protective equipment, and if they do, there is no regular inspection or testing of this equipment.

Environmental Life Cycle Assessment of a U.S. Hospital-based Radiology Practice.

Background Climate change, driven primarily by human-induced greenhouse gas (GHG) emissions, poses major risks to human health. Health care contributes 8.5% of GHG emissions in the United States. Purpose To estimate the life cycle environmental impact of diagnostic radiology services within a single academic medical center. Materials and Methods This process-based life cycle assessment (LCA) of a diagnostic radiology department serving adult inpatient, outpatient, and emergency department patients in a U.S. hospital followed International Organization for Standardization (ISO 14040:2006) guidelines. System components included production and distribution of imaging equipment; energy use of imaging equipment, including MRI, CT, radiography and fluoroscopy, and US; production and use of other capital equipment; production of single-use, semidurable, and durable supplies and linens; and production and energy use from onsite data storage. Meters monitored the power usage of selected imaging equipment during April 2023. Modeling assumed an equipment lifespan of 10 years. Results are reported in kilotons of CO2 equivalent (kt CO2e) emissions per scan and over a 10-year period. A sensitivity analysis assessed variability of data. Results Over a decade, these radiology services generated 4.6 kt CO2e GHG emissions, with MRI responsible for 48% (2.2 of 4.6 kt CO2e) and CT responsible for 24% (1.1 of 4.6 kt CO2e) of cumulative emissions. Clinical use of imaging equipment (all modalities) accounted for 54% of departmental GHGs (2.5 of 4.6 kt CO2e). Other notable contributions include the production of imaging equipment (11%, 0.49 of 4.6 kt CO2e), the production and use of picture archiving and communication system workstations (11%, 0.48 of 4.6 kt CO2e), and linens production and laundering (10%, 0.47 of 4.6 kt CO2e). Conclusion Energy consumption from clinical use of imaging equipment accounted for more than 50% of departmental GHG emissions, with MRI and CT equipment as the major emitters. Other notable GHG contributors include the production of imaging equipment, the production and use of picture archiving and communication system workstations, and linens production and laundering. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Thrall in this issue.

Platelet Indices in Patients With Gram-Negative and Gram-Positive Sepsis: A Retrospective Cross-Sectional Study.

Different inflammatory processes and sepsis can significantly affect the number of platelets and platelet indices. Therefore, in this study, total platelet count (PLT), thrombocrit (Pct), platelet distribution width (PDW), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were analyzed in patients with Gram-negative and Gram-positive bacterial sepsis and in sterile blood cultures. Inclusion criteria were an increased number of inflammatory parameters (elevated values ​​of leukocytes,C-reactive protein (CRP), procalcitonin (PCT), andpositive blood culture. Exclusion criteria were patients who did not have elevated values ​​of inflammatory parameters and did not have a positive blood culture.Samples were collected from patients who had sepsis confirmed by blood cultures at the Department of Microbiology and Molecular Diagnostics at University Clinical Hospital Mostar in the period from 2019 to 2022. Three groups were analyzed, patients who had sterile blood cultures, patients with blood cultures with isolated Gram-positive bacteria, and patients with blood cultures with isolated Gram-negative bacteria. Specific infectious agents were identified for each group of patients. In addition to the above, PLT, Pct, MPV, PDW, P-LCR, PCT, CRP, the total number of leukocytes, and the number of neutrophil leukocytes were analyzed in each group. The values of PCT, CRP, and the number of neutrophile leukocytes were significantly higher in patients with Gram-negative sepsis as compared to Gram-positive sepsis and to control group. Patients with sepsis have decreased PLT and Ptc and increased values of MPV, PDW, and P-LCR. In sepsis caused by the Gram-negative bacteria, i.e., Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii, the values of the same parameters were more changed compared to sepsis caused by Gram-positive bacteria, i.e., Streptococcus pneumoniae, Enterococcus spp., and methicillin-resistant Staphylococcus aureus (MRSA). When comparing Gram-negative negative bacteria, PLT was lowest in sepsis caused by Escherichia coli, the PDW value was highest in sepsis caused by Acinetobacter baumannii, and MPV and P-LCR were the highest in sepsis caused by Klebsiella pneumoniae. Our study showed that platelet indices are significantly changed in patients with sepsis. Patients with sepsis have decreased values of PLT and Pct and increased values of MPV, PDW, and P-LCR, indicating an increase in thrombocyte production. Moreover, the results were more prominent in sepsis caused by Gram-negative bacteria compared to sepsis caused by Gram-positive bacteria.

Diagnostic reference levels for the city of Moscow during X-ray examinations

Diagnostic reference levels are one of the effective tools for optimizing patient radiation doses in diagnostic radiology. The staff of domestic radiology departments does not have an understanding of the development process and use of diagnostic reference levels during X-ray examinations, although this tool is a generally accepted in practice abroad. The article shows the experience of forming regional diagnostic reference levels based on measurements provided by the accredited testing laboratory of the Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department. The diagnostic reference levels for radiography in Moscow were developed for eight of the most common types of examinations based on the operation of 216 digital X-ray machines. The resulting levels, expressed in the dose-area product (cGy-cm2) and effective dose (mSv), were compared with the local diagnostic reference levels for the Ryazan region, Russia, and national diagnostic reference levels for other countries. The analysis showed continuity in the values. Some types of studies have been optimized. The developed diagnostic reference levels are the quality performance indicators foe diagnostic radiology departments and will be used to optimize a patient radiation dose during diagnostic studies in Moscow.

Problems of management of patient biological waste in radionuclide diagnostics

Biological excretion from patients (urine) generated during radionuclide diagnostics enters directly into the hospital sewage system. The establishment of new clearance level according to Resolution of the Government of the Russian Federation No. 1069 of October 19, 2012 may entail amendments to regulatory documents for radionuclide diagnostics departments. One of these requirements is a mandatory dedicated sewage system. Establishment of the requirement may lead to an increase the cost of the radionuclide diagnostic examinations, and to a decrease the accessibility of radionuclide diagnostic. The aim of this study was to estimate the activity of radionuclides in patient urine after radionuclide diagnostic and activity concentration in sewage water in the hospital and in the transport tank of toilet for evaluation of paths of waste manage. Based on published literature data, models of biological excretion were constructed for the following radiopharmaceuticals: 99mTc-pyrophosphate, 64Cu-Labeled Monoclonal Antibody, 18F-FDG, 68Ga-PSMA-617. The activity of radionuclides in the patient waste in the hospital and in public transport during the patient transportation to home was calculated. Various scenarios of patient transportation were considered. The values of the excreted activity, activity concentration and dose rate at 1 m from the tank with sewage water for each type of transport were calculated. The calculated values of the radionuclide activity concentration in sewage water in transport tank of toilet for the majority scenarios exceed the clearance level (up to 180 times for 68Ga-PSMA-617 when traveling by bus). According the regulatory requirements, it is necessary to collect patient excretions after radionuclide diagnostic examinations and hold it for decay. However, estimated effective doses of individuals from the public from contact with biological patient waste do not exceed the acceptable value. This is due to the short half-life of diagnostic radionuclides. The paths of management system of biological patient waste were proposed.

Job satisfaction and career plans among Irish radiography services managers and clinical specialist radiographers

IntroductionRadiography Service Managers (RSMs) and Clinical Specialist Radiographers (CSRs) play a pivotal role in the overall provision and seamless operation of the diagnostic imaging services provided to patients. The essential role played by these professionals makes it important to consider both job satisfaction and career plans amongst this cohort as both these variables are inextricably linked with the quality of care provided to patients and the occupational performance of staff. This study explored the job satisfaction and career plans of RSMs and CSRs. MethodA well-established, validated, questionnaire-based job satisfaction assessment tool, the Job Satisfaction Survey (JSS), was used to provide data relating to 36 statements across nine subscales related to job satisfaction in healthcare. Additionally, there were four open-ended questions which provided participants the opportunity to provide input related to career plans. An email link with access to the electronic survey was circulated to the National RSMs Group who further distributed the survey to other RSMs and all CSRs at their respective clinical sites. The collected data was analysed in Excel with the data analysis add-in to assess statistical significance. ResultsThe findings of this study demonstrated predominately ‘ambivalent’ opinions among CSRs and RSMs, with regard to job satisfaction. Areas of highest satisfaction amongst both cohorts included ‘Nature of work’, ‘Co-workers’, and ‘Supervision’, while areas of dissatisfaction included ‘Pay’, unclear systems of ‘Contingent Rewards’, and ‘Operating Conditions’. ConclusionThis study highlighted areas where measures could be explored to increase job satisfaction and encourage the retention of both RSMs and CSRs in diagnostic imaging departments. Implications for practiceThe enhancement of job satisfaction at management levels should translate through to other grades of radiographers, impacting the overall quality of patient care and professional well-being in the department.

Radiation dose to health care workers measured by thermoluminescent dosimetry

To evaluate radiation dose among physicians, nurses, nuclear medicine (NM) technicians, and radiographers at a single institution and to compare the difference in the measured dose during COVID-19 with other periods. A retrospective analysis of the occupational radiation doses received by all workers in diagnostic radiography and NM departments at a single institution during a 5-year period (2018-2022) was performed. Dose measurements were recorded for 94 radiology personnel: radiographers, NM technicians, physicians, and nurses. In addition to descriptive statistics, the Mann-Whitney U-test was used to compare the average annual effective dose between male and female workers and between the periods before and during COVID-19. Kruskal-Wallis test was used to compare effective radiation doses from different quadrants. The annual average effective doses were found to be between 0.58 and 0.72 mSv for males and 0.68 and 0.85 mSv for females. All radiographers, 86% of nurses, and 69% of physicians have received annual average effective doses below 0.99 mSv. The average annual effective doses for all radiation workers were similar in the period before COVID-19 when compared to the period during COVID-19 except for nurses who had significantly lower (P<0.05) doses before COVID-19. The average annual effective doses of radiation workers during 2018-2022 were well below the annual dose limit. A relatively higher average effective dose was received among NM technicians compared with other radiation occupational workers. While the caseload during the COVID-19 pandemic was lower due to government policies, the radiation dose to healthcare workers during the pandemic was similar to that before the pandemic.

Value of Breast Elastography in Evaluation of Breast Masses on Screening Ultrasound

Abstract Background Breast cancer is a global health burden and a leading cause of death in females worldwide, breast cancer alone accounts for 25% of all cancer cases and 15% of all cancer death among females. Its high incidence has led to improve patient's mortality rate. Breast cancer is the most common female neoplasm (31% of tumors in females), and the second-leading cause of death among women. Objective To evaluate the additional value of Elastography as complementary to conventional US in breast masses found on screening US. Methods The study was performed prospectively between August 2022 and January 2023 at Ain Shams University hospitals at diagnostic radiology department in 30 consecutive female patients who met all the inclusion criteria with no exclusion criteria. Results A total of 30 patients were included in our study with a mean age of 39.40 years (range 17 - 79 years). On Histopathological Evaluation, 9 (30%) lesions were malignant and 21(70%) were benign. The calculated sensitivity of Semiquantitative Elastography was 100%, specificity was 95.2% and the total accuracy was 96.7%. The PPV &amp; NPV were 90% &amp; 100% respectively. In our study, the best cut off value for Strain Ratio to differentiate between benign and malignant breast entities was found to be at 3.6 level (AUC, 0.984). It allowed significant differentiation between benign and malignant lesions (p &amp;lt; 0.001). Which considering lesions with a Strain Ratio ≤ 3.6 as benign and lesions with a Strain Ratio &amp;gt; 3.6 as malignant. Conclusion Breast Ultrasound Elastography is a useful imaging modality resulting in increase specificity and sensitivity in diagnosing different breast lesions. Breast Elastography provides useful information about distinguishing benign and malignant lesions. Thus, consideration of lesion stiffness could increase positive predictive values and reduce unnecessary benign biopsies and render better diagnostic results.

Optical Methods for Optimizing Fluorescence Imaging Field of View and Image Quality in Surgical Guidance Procedures.

Cancer surgery is aimed at complete tumor resection and accurate lymph node detection. However, numerous blood vessels are distributed within the tumor, and the colors of the tumor, blood vessels, and lymph nodes are similar, making observations with the naked eye difficult. Therefore, tumors, blood vessels, and lymph nodes can be monitored via color classification using an operating microscope to induce fluorescence emission. However, as the beam width of the LED required to induce fluorescence emission is narrow and the power loss of the beam is significant at a certain working distance, there are limitations to inducing fluorescence emission, and light reflection occurs in the observation image, obstructing the view of the observation area. Therefore, the removal of reflected light is essential to avoid missing the diagnosis of the lesion under observation. This paper proposes the use of a beam mirror and polarizing filter to increase the beam width and beam intensity. The refraction and reflection effects of the beam were utilized using the beam mirror, and the rotation angle of the polarizing filter was adjusted to remove light reflection. Consequently, the minimum beam power using the beam mirror was 10.9 mW, the beam width was doubled to 40.2°, and more than 98% of light reflection was removed at 90° and 270°. With light reflection effectively eliminated, clear observation of lesions is possible. This method is expected to be used effectively in surgical, procedural, and diagnostic departments.

A study on the relationship between job-stress and burnout: Focusing on job domain among medical technologists in South Korea

This study analyzed the relationship between job stress and burnout among medical technologists in South Korea by job domain. Most job stress factors showed significant correlations with burnout. Among the job stress factors, job demand, job instability, lack of reward, and occupational climate had significant impacts on burnout scores, with occupational climate exerting the greatest influence. In analysis of job stress factors influencing burnout according to job domain, the diagnostic testing department was most affected by lack of reward. In the departments of pathological examination, physiological testing, and health screening, occupational climate had a significant impact on burnout scores. This study demonstrated that the job-related stress experienced by medical technologists in South Korea is closely associated with burnout. To maintain work efficiency, it is essential that job-related burnout be addressed.

Stress-induced phosphoprotein 1 (STIP1) gene expression in adenomyosis: An observational case-control study

Background. Endometriosis is distinguished by its high prevalence and significant impact on the quality of life and reproductive health of women; however, its etiology and essential pathogenesis of remain uncertain so far. Modern research is increasingly focusing on immune, hormonal and genetic factors that share a common structure and participate in common metabolism — so-called single nucleotide polymorphisms (SNPs), including stress-induced phosphoprotein 1 (STIP1), which participates in tissue and cellular metabolism through transcription splicing and folding of RNA. The role of this protein, known as heat shock protein (HSP)-organizing protein, is being actively studied in cancer and hyperproliferative diseases. The role of the STIP1 gene and its product in the pathogenesis of adenomyosis appears to be studied insufficiently, thereby determining the relevance of the present study.Objectives. To evaluate the expression of stress-induced phosphoprotein 1 in eutopic endometrium and myometrium in women with isolated adenomyosis, as well as in combination with other benign hyperproliferative diseases of the reproductive system.Methods. Clinical study site: Clinical and Diagnostic Department of Ott Research Institute of Obstetrics, Gynecology and Reproductology. Design: an observational case-control study of patients with verified diagnoses of diffuse adenomyosis, uterine fibroids, and external genital endometriosis (main group — n = 55). The study group (n = 43) was divided into three subgroups: patients with isolated diffuse adenomyosis (AM, n = 16), adenomyosis in combination with uterine fibroids (AM + UF, n = 16), adenomyosis in combination with external genital endometriosis (AM + EGE, n = 11)), a comparison group — patients with uterine fibroids (n = 12) and a control group (n = 17) — women of reproductive age without gynecological diseases. The study was conducted from November 1, 2022 to September 30, 2023. The target indicator of the study was the level of relative mRNA (mRNA) expression of STIP1 gene (in RQ (Relative Quantity) units) in the uterus — adenomyosis glands, surrounding myometrium and endometrium. Histological evaluation of the endometrium served as an additional indicator. Statistical analysis of the results obtained, namely the relative level of mRNA expression, was carried out by the ΔΔСt method using the Expression Suit V1.0.3 program. (https://www.thermofisher.com/ru/ru/home/technical-resources/software-downloads/expressionsuite-software.html). The data analysis was performed using the GraphPad Prizm program (Insight Partners, USA). Differences between groups were evaluated by means of single factor ANOVA analysis (followed by post-hoc pairwise comparisons (Tukey test) of the values in each group. The differences were considered statistically significant at p &lt; 0.05.Results. A high level of STIP1 gene expression was reported in myometrium of patients with isolated adenomyosis (more than 3-fold increase in relation to the comparison group — patients with uterine fibroids). In addition, myometrium of women with adenomyosis combined with uterine fibroids demonstrated a higher expression of STIP1 gene, compared to patients with isolated uterine fibroids (p &lt; 0.01). The evaluation of the expression of mRNA of the STIP1 gene in the eutopic endometrium of patients with adenomyosis and women in the control group revealed no significant differences; however, STIP1 in the endometrium of women with adenomyosis was significantly lower than in the endometrium of both patients with uterine fibroids and women with adenomyosis combined with external genital endometriosis.Conclusion. Increased mRNA expression of STIP1 gene in myometrium in adenomyosis confirms its role in the pathogenesis of this disease. The role of the expression of the STIP1 gene and the corresponding protein is to be further clarified in order to assess its specificity and sensitivity as a diagnostic marker and to identify new approaches to the treatment of adenomyosis.

Идентификация гаплотипов фертильности крупного рогатого скота

Abstract. An analysis of the reproduction rates of modern Holstein cattle populations has shown that one of the key factors influencing the decline in the reproductive qualities of cows are genetic factors. In recent decades, a large amount of data has accumulated on the presence in the genome of recessive mutations in the DNA sequence, which in the homozygous state reduce the reproductive functions of animals, causing embryonic mortality. The use of a limited number of outstanding sire bulls for artificial insemination has reduced the original genetic diversity. In this regard, the identification and determination of fertility haplotypes in populations has recently become an integral part of breeding work with cattle. Genotyping of 584 heads of Holstein cattle from 2 farms in the Sverdlovsk region was carried out in order to identify heterozygous carriers of anomalies: HH0 (FANCI), HH1 (APAF1), HH3 (SMC2), HH4 (GART), HH5 (TFB1M), HH6 (SDE2), HH7 (CENPU), HHB (ITGB2, BLAD), HHC (SLC35A3, CVM), RABGGTB, RNF20 and TTF1. The scientific novelty lies in determining the frequency of occurrence of fertility haplotypes that have not previously been studied in the Sverdlovsk region. The purpose of the study is to determine the frequency of occurrence of fertility haplotypes of Holstein cattle in populations of the Sverdlovsk region. Research methods. To diagnose mutations, we used test systems developed in the Laboratory of Molecular Basis of Breeding, Department of Biotechnology and Molecular Diagnostics of Animals, L. K. Ernst Federal Research Center. Results. The number of fertility haplotypes in the studied herds differed not only in the frequency of occurrence of the defect, but also in the number of types of detected haplotypes. In the population of “Kamenskoye” JSC, the largest number of animals were carriers of fertility haplotypes HH4 and HH3 with a carriage frequency of 1.891 and 1.412 %, respectively; the educational and experimental farm identified the largest number of haplotypes HH3 and HH6 with a carriage frequency of 4.082 %.

Ihor Volodymyrovych Kotulskyi

Domestic medicine suffered a heavy loss: a talented scientist, head of the department of pathophysiology, anesthesiology and functional diagnostics, candidate of medical sciences Ihor Volodymyrovych Kotulskyi passed away.

Assessing the impact of nodule features and software algorithm on pulmonary nodule measurement uncertainty for nodules sized 20 mm or less.

Measurements are not exact, so that if a measurement is repeated, one would get a different value each time. The spread of these values is the measurement uncertainty. Understanding measurement uncertainty of pulmonary nodules is important for proper interpretation of size and growth measurements. Larger amounts of measurement uncertainty may require longer follow-up intervals to be confident that any observed growth is due to actual growth rather than measurement uncertainty. We examined the influence of nodule features and software algorithm on measurement uncertainty of small, solid pulmonary nodules. Volumes of 107 nodules were measured on 4-6 repeated computed tomography (CT) scans (Siemens Somatom AS, 100 kVp, 120 mA, 1.0 mm slice thickness reconstruction) prospectively obtained during CT-guided fine needle aspiration biopsy between 2015-2021 at Department of Diagnostic, Molecular, and Interventional Radiology in Icahn School of Medicine at Mount Sinai, using two different automated volumetric algorithms. For each, the coefficient of variation (standard deviation divided by the mean) of nodule volume measurements was determined. The following features were considered: diameter, location, vessel and pleural attachments, nodule surface area, and extent of the nodule in the three acquisition dimensions of the scanner. Median volume of 107 nodules was 515.23 and 535.53 mm3 for algorithm #1 and #2, respectively with excellent agreement (intraclass correlation coefficient =0.98). Median coefficient of variation of nodule volume was low for the two algorithms, but significantly different (4.6% vs. 8.7%, P<0.001). Both algorithms had a trend of decreasing coefficient of variation of nodule volume with increasing nodule diameter, though only significant for algorithm #2. Coefficient of variation of nodule volume was significantly associated with nodule volume (P=0.02), attachment to blood vessels (P=0.02), and nodule surface area (P=0.001) for algorithm #2 using a multiple linear regression model. Correlation between the coefficient of variation (CoV) of nodule volume and the CoV of the x, y, z measurements for algorithm #1 were 0.29 (P=0.0021), 0.25 (P=0.009), and 0.80 (P<0.001) respectively, and for algorithm #2, 0.46 (P<0.001), 0.52 (P<0.001), and 0.58 (P<0.001), respectively. Even in the best-case scenario represented in this study, using the same measurement algorithm, scanner, and scanning protocol, considerable measurement uncertainty exists in nodule volume measurement for nodules sized 20 mm or less. We found that measurement uncertainty was affected by interactions between nodule volume, algorithm, and shape complexity.

Development and Validation of Survey Instrument for Measurement of Hospital Functional Service Quality

Background: Emergency, diagnostics, and surgical services are critical areas of hospitals both in terms of technicalities and resource creation. The literature review reflects that there is a need to develop a survey instrument-based measurement model that can identify areas of functional service quality within hospital facilities based on patients’ perspectives as hospital quality improvement initiatives. Objective: To design and validate an instrument that helps to evaluate the functional service quality of hospitals using structural equation modeling. Methods: It was a mixed-method research having a cross-sectional study design. A total of 817 responses were purposively collected from consumers of surgical, emergency, and diagnostic departments of tertiary care hospitals. Simple descriptive, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was performed to identify the factors to formulate the instrument using SPSS Amos 20.0 Results: The study validated seven constructs for the development of Func.Qual (Survey instrument named to measure hospital functional service quality). Amongst these constructs’ assurance, responsiveness communication, and reliability are critical contributing factors reported earlier. Whereas promptness, food and aesthetics are new constructs extracted in local settings. The values of goodness of model fit indices found statistically valid with Comparative Fit Index (CFI=0.96), Root Mean Square Error of Approximation (RMSEA=0.055) and Standardized Root Mean Square Residual (SRMR=0.05). Conclusion: Func.Qual is a powerful survey instrument to measure hospital functional service quality. The current study is an effort to enrich the literature associated with the body of knowledge for hospital functional service quality.

Suočavanje sa stresom i mentalno zdravlje zatvorenika

Prison is a high stress environment where an individual's mental health can be seriously affected (Mansoor et al., 2015). The way prisoners cope with stress is an important factor in examining the impact of the prison environment on their mental health (Gullone et al., 2000). The aim of this study is to examine the relationship between prisoners' coping strategies and their mental health within the framework of the health theory of coping (Stallman, 2020). The study was conducted on a sample of N=125 male prisoners who were in the Diagnostic Department of the Diagnostic Centre in Zagreb (M=40.08; SD=11.97). The Multidimensional Coping Scale (Duhachek, 2005) and DASS-21 (Lovibond &amp; Lovibond, 1995) were used. Participants were also asked to rate the intensity of emotions they had experienced in the past week. The results show that only unhealthy coping strategies make a significant contribution to explaining prisoners' anxiety, while both healthy and unhealthy coping strategies contribute to explaining prisoners' depression. The results do not confirm the premise of the theory that the frequency of using stress coping strategies is negatively associated with the intensity of experiencing unpleasant emotions. The results are discussed in relation to the theoretical framework and their practical applicability.

Concerning on different types of transthoracic echocardiography

The article discusses the evolution of transthoracic echocardiography due to the introduction into clinical practice of new technologies and methods of cardiac ultrasound and the development of pocket ultrasound devices. Often, new technologies did not replace the old ones but were used as an addition to them, which led to an increase in the duration and complexity of the examination. On the other hand, the use of portable ultrasound machines has made it possible to perform point-of-care transthoracic echocardiography, but it has been limited by solving a specific clinical problem. It became clear that different clinical situations require examinations that differ in complexity, labor intensity, levels of experience, and training of the doctors. Various types, features, and place in the clinical practice of transthoracic echocardiography are presented. The necessity of changing approaches to both accounting for effort estimates depending on the protocols and volumes of examinations and to planning the work of ultrasound and functional diagnostics departments is substantiated. Ways to solve problems that hinder the introduction of targeted, including focused, examinations into routine clinical practice are proposed.

Effect of contextual factors on the prevalence of diagnostic errors among patients managed by physicians of the same specialty: a single-centre retrospective observational study

BackgroundThere has been growing recognition that contextual factors influence the physician’s cognitive processes. However, given that cognitive processes may depend on the physicians’ specialties, the effects of contextual factors on...