Mean Number Of Studies Research Articles

The 100 most-cited articles on pelvic organ prolapse: A bibliometric analysis

Objective: This study aimed to analyze the top 100 most cited papers in the field of pelvic organ prolapse by utilizing bibliometric methods. Methods: On the 1st of October 2022, articles with the title pelvic organ prolapse were listed in order of citation on the Web of Science database. The first 100 articles were included in the study without a publication time limit. The number of citations, number of citations/year, title, author, journal, publication year, country and institutional information of the articles were recorded. Results: The highest number of citations in the first 100 most cited studies was 3,081 while the lowest was 95. The mean total number of citations of the 100 most cited studies was 248.7±380.2. The annual mean number of citations of the studies ranged between 118.5 and 3.7 and the mean number of studies was 16.8±17.8. In the ranking of the most cited papers, three journals were included in the list 70 times in total, accounting for 70% of the articles. Pelvic floor exercises were mentioned in 27 articles in total. Conclusions: This study provides medical researchers with bibliometric information relating to pelvic organ prolapse. The United States was clearly ahead in our study in terms of first authors, institutions, and journals. Articles on incontinence had more citations per year. Pelvic organ prolapse has serious sociological and economic consequences. We anticipate an increase in research on preventive factors such as pelvic exercise in the future.

Brolucizumab in Neovascular Age-Related Macular Degeneration - Indian Real-World Experience: The BRAILLE Study - Fifty-Two-Week Outcomes.

To report the 52-week real-world efficacy and safety outcomes of brolucizumab therapy for neovascular age-related macular degeneration (nAMD) in Indian eyes. A retrospective, multicentre chart analysis of 82 eyes of 82 patients with nAMD (switch therapy: 65 eyes; treatment-naïve: 17 eyes) with 52-week follow-up data was performed. Pro-re-nata re-treatment was offered based on visual and tomographic criteria. Changes inbest-corrected visual acuity (BCVA), intraretinal fluid (IRF), subretinal fluid (SRF), central-subfield thickness (CST), and pigment epithelial detachment (PED) were the key outcome measures, coupled with the safety profile. The mean age of the study population was 67.65 (±10.67) years, with 57 male patients (69.5%). The study's mean number of injections was 4.8 (± 0.77). After brolucizumab therapy, the BCVA improved significantly at weeks 4 (P<0.001), and maintained up to week 52 (P<0.001). The CST also reduced significantly at all the visits (Baseline: 413.6 ± 64.6 µm; 52-week: 292.37 ± 13.5 µm; P<0.001). Significantly fewer eyes demonstrated residual SRF (P<0.001) and IRF (P<0.001) at all visits, starting with week 12 and continuing until week 52. The PED resolution was significant from week 24 through week 52 (P=0.004). Each of the 82 eyes received four injections of brolucizumab, with 63.4% (52 eyes) receiving a fifth dose and only 17.1% requiring a sixth. Mild intraocular inflammation (IOI) was seen in three eyes (3.66%) that resolved conservatively. One patient (1.2%) developed mild fever that subsided with oral medications. The 52-week BRAILLE study demonstrates that brolucizumab is effective and safe in nAMD eyes in a real-world setting. Brolucizumab treatment can reduce the therapeutic burden in patients with nAMD due to its rapid, sustained efficacy and favourable safety profile.

Palliative care and imaging utilisation for patients with cancer

ObjectiveThis observational study explores the association between palliative care (PC) involvement and high-cost imaging utilisation for patients with cancer patients during the last 3 months of life.MethodsAdult patients with cancer...

Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable?

Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable?

Performance of Pediatric Neuroradiologists Working from Home during a Pandemic at a Quaternary Pediatric Academic Hospital.

As a result of the coronavirus disease 2019 (COVID-19) pandemic, many radiology departments shifted to working a portion of clinical assignments from home. To determine the effect of working from home on performance, productivity, quality, and safety, we evaluated turnaround time, volume of studies, and error rates on rotations worked from home compared with in the hospital. The number of studies interpreted per day for each neuroradiologist, turnaround times, and error rates reported to peer learning was identified from April 1, 2020, through September 30, 2020. For each neuroradiologist, mean turnaround times and volumes per day at home versus in the hospital were compared. Similar comparison was performed for STAT studies. During the time period, 2597 CTs (1897 at home, 700 in the hospital) and 3685 MRIs (2601 at home, 1084 in the hospital) were read. By individual neuroradiologists, 57% (4/7) had shorter turnaround time at home and 57% (4/7) demonstrated an increase in the mean number of studies per day read at home. No statistically significant difference was noted in the neuroradiologists' performance while reading STAT studies. Reported error rates were not found to be higher at home, with statistically significantly lower rates when working at home (P = .018). Variable productivity and performance of neuroradiologists when working from home versus in the hospital were found, being 57% faster and/or more productive while working at home without an increase in error rates. The decision to work at home versus in the hospital may best be based on local factors, balancing the variability among individual neuroradiologist's and the institution's needs, recognizing that working from home is not a one-size-fits-all phenomenon but requires adaptability for successful implementation.

HSR19-087: Intensity of Symptom Management After Palliative Care Referral Not Associated With Reduced Imaging Intensity for Cancer Patients During the End-of-Life Period

Purpose: For patients with advanced cancer, palliative care (PC) referral itself results in improved quality of life and lower total health care costs. While our earlier research suggests that PC referral alone does not appear to affect imaging utilization, the effect of the intensity of services for PC symptom management on utilization of imaging services is unknown. We sought to evaluate whether an association exists between the intensity of PC symptom management services and utilization of high-cost imaging at the end-of-life. Methods/Materials: Adult cancer patients who died between January 1, 2012–May 31, 2015 were identified. A PC symptom management intensity score was determined for each patient during the last year of life based upon the number of inpatient and outpatient PC service visits and the number of problems addressed within the 8 defined domains for palliative care. Frequency of utilization of nonemergent oncologic imaging was determined for the last 3 months and the last month of life. Using chi-square and Wilcoxon-rank sum tests, effects of low (&lt;20th percentile) and high (&gt;80th percentile) PC symptom management intensity score on the proportion of patients imaged and mean number of studies per patient (mean imaging intensity [MII]) were compared for the last 3 months and last month of life. Results: 3,772 decedents were included, with 3,523 (93.4%) never referred to PC and 249 (6.6%) referred to PC, largely before the last month of life (70.3%). Within the last 3 months and last month of life, the proportion of patients imaged was significantly greater (P&lt;.001) in patients with high PC symptom management intensity scores when compared to those with low PC symptom management intensity scores. There was no significant difference in the mean number of imaging studies received by either group in the last 1 month or 3 months of life. (P&gt;.05). Conclusions: The intensity of PC symptom management in end-of-life oncologic care was not associated with decreased use of nonemergent, high-cost cancer imaging in our cohort. This may suggest an opportunity for reduced high-cost imaging through further clarification of the goals of care with both patients and oncologists, although the role of imaging in the setting of PC during the end-of-life period warrants further study as well.

Risk of ionizing radiation exposure from CT scans in the Neuro ICU - a patient safety blind spot?

Introduction: The exposure to ionizing radiation has increased significantly with the wide availability of computed tomography (CT) scans and portable imaging technology. We examine the pattern of use of inpatient diagnostic imaging and radiation exposure in the neuro-intensive care unit (Neuro ICU, N-ICU) patient population at a large academic medical center. Methods: We retrospectively evaluated all patients admitted to the Neuro ICU at our academic medical center from January 1 to December 31, 2013. The number and type of CT studies was collected, and the corresponding estimated radiation dose was calculated. We limited the evaluation to CT scans, which accounts for the majority of radiation exposure. Data were electronically collected and cross-referenced to the patients’ electronic medical records (EMR) and radiology records. Radiation dose estimates were calculated based on published reference values and conversion factors (CT head (2mSv)), CT angiography of the head and neck (7-10 mSv), Ct Chest /Abd/pelvis ( 10 mSv), CT cerebral perfusion analysis (3.3 mSv). Results: In the calendar year 2013, we had a total of 2353 admission encounters (F=1078). The mean age on admission was 56.55Y ± 16.7. The mean length of ICU stay was 6.3 days. Mechanical ventilation was initiated on 420 patients with a mean length on mechanical ventilation 5.09 days. 2028 CT scans were completed of which approximately 60% were head CT without contrast (n=1209). 379 patients had multiple CT studies. The mean number of studies was 3.8 ± 2. The number of patients with more thanthree3 studies during their ICU stay was 159. The maximum number of studies on a single patient was 21. Conclusion: Patients in the Neuro ICU are at a risk for significant exposure to ionizing radiation. Radiation exposure must be factored into the culture of quality and patient safety in the ICU.

The efficacy of flupenthixol decanoate in bipolar disorder patients who have no sufficient remission with existing treatments

Objective: It is aimed to evaluate the prophylactic effect of flupenthixol decanoate in remitted BD patients. Methods: Remitted patients with bipolar disorder (BD), who had at least one mood episode each year in the last five years in spite of adequate pharmacotherapy, were included. Flupenthixol decanoate 20 mg/ml was administered in every two weeks. Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Bipolar Disorder Functioning Questionnaire (BDFQ), General Assessment of Functionality (GAF) and Side Effect Rating Scale (UKU) were applied. Patients were followed up for 12 months. Results: Eight patients with a mean age of 34.7±7.5 were enrolled to the study. None of the patients were under monotherapy before the study enrollment. Three (37.5%) of the three patients were dropped out. The data of remaining 5 patients’ were evaluated. At the end of the study mean number of mood episodes declined to 0.2±0.4 per year indicating a statistical significance and the mean score of BDFQ declined to 119.6±2.7. Conclusions: Flupenthixol decanoate significantly improved functionality and decreased the number of mood episodes allowing an alternative treatment even in remitted BD patients. OZET

Burden of Medical Radiation Exposure in Children with Sickle Cell Disease.

Abstract 1525Poster Board I-548 BACKGROUNDChildren with sickle cell disease (SCD) present to medical attention repeatedly throughout childhood for medical complications. Chest radiographs are often obtained for fever and respiratory symptoms, and plain radiographs are often ordered because of bone pain. Computed tomography (CT) and nuclear medicine (NM) studies may also be obtained for other complications. Exposure to medical radiation may increase the risk of cancer, especially in children. Growing children are inherently radiosensitive because of their high proportion of dividing cells, and children have more remaining years of life than adults during which cancer can develop. Therefore, it is important to determine the magnitude of medical radiation exposure in children with SCD because they could be so frequently exposed. METHODSWe reviewed the medical records for all members of the Dallas Newborn Cohort (Blood 2004;103:4023-7) to determine the number and type of radiographic studies each individual received from 1996 to the present. We recorded the type of radiographic study, body location, clinical indication, date of study, age at the time of study, and the number and types of views when applicable. We also recorded slice thickness and mode for CT scans as well as injection activity, radionuclide, and type of radiopharmaceutical for nuclear medicine studies. To account for different lengths of follow-up, we standardized the number of radiographic studies to yearly rates for each individual to determine the projected number of studies a SCD patient would receive by 18 years of age. RESULTSWe studied 938 patients (52.8% male) with a mean follow-up of 9.4 years (median 9.2, range 0.1 – 20.6). 571 had sickle cell anemia (SS), 283 had sickle-hemoglobin C disease (SC), 63 had Sβ+-thalassemia (Sβ+), and 21 had Sβ0-thalassemia (Sβ0). We identified 9,246 radiographic studies, including 8,697 radiographs, 441 CT scans, and 108 NM studies. 711 (76%) patients had at least one radiographic study. Patients with SS or Sβ0 were more likely to have had at least one radiographic study than those with SC or Sβ+ (77% vs. 65%; P<0.0001). The mean number of studies per patient was 9.9 [95% confidence interval (C.I.) 8.9 – 10.9; range 0 – 115], corresponding to a mean rate of 1.5 per year (95% C.I. 1.3 – 1.6; range 0 – 27.3). We project that a patient with SCD will be exposed to the radiation from 26.7 (95% C.I. 24.1 – 29.3; range 0 – 492.1) radiographic studies by 18 years of age. Approximately 5% of patients with SCD will be exposed to 100 or more radiographic studies during childhood. CONCLUSIONSChildren with SCD are frequently exposed to medical radiation. Some are exposed to over 100 radiographic studies. Radiographs of the painful part are frequently obtained but are infrequently indicated. Because growing children are more radiosensitive than adults and have more remaining years of life, medical radiation exposure could be clinically significant. We are now calculating the radiation effective doses for this cohort to quantify the risk of malignancy. It is prudent to limit the medical radiation exposure of this high-risk population. DisclosuresNo relevant conflicts of interest to declare.

Cumulative Radiation Dose Caused By Radiologic Studies in Critically Ill Trauma Patients

Critically ill trauma patients undergo many radiologic studies, but the cumulative radiation dose is unknown. The purpose of this study was to estimate the cumulative effective dose (CED) of radiation resulting from radiologic studies in critically ill trauma patients. The study group was composed of trauma patients at an urban Level I trauma center with surgical intensive care unit length of stay (LOS) greater than 30 days. The radiology records were reviewed. A typical effective dose per study for each type of plain film radiograph, computed tomographic scan, fluoroscopic study, and nuclear medicine study was used to calculate CED. Forty-six patients met criteria. The mean surgical intensive care unit and hospital LOS were 42.7 +/- 14.0 and 59.5 +/- 28.5 days, respectively. The mean Injury Severity Score was 32.2 +/- 15.0. The mean number of studies per patient was 70.1 +/- 29.0 plain film radiographs, 7.8 +/- 4.1 computed tomographic scans, 2.5 +/- 2.6 fluoroscopic studies, and 0.065 +/- 0.33 nuclear medicine study. The mean CED was 106 +/- 59 mSv per patient (range, 11-289 mSv; median, 104 mSv). Among age, mechanism, Injury Severity Score, and LOS, there was no statistically significant predictor of high CED. The mean CED in the study group was 30 times higher than the average yearly radiation dose from all sources for individuals in the United States. The theoretical additional morbidity attributable to radiologic studies was 0.78%. From a radiobiologic perspective, risk-to-benefit ratios of radiologic studies are favorable, given the importance of medical information obtained. Current practice patterns regarding use of radiologic studies appear to be acceptable.

Resistance Index of Cerebral Artery Blood Flow Impedance in Preterm Neonates.† 939

Color flow and pulsed Doppler ultrasonography provides non-invasive estimates of blood flow impedance and has been applied to the evaluation of hemodynamics in newborns. Specctral doppler flow profiles of middle and anterior cerebral arteries of 151 preterm neonates <35 wks GA were obtained with an Acuson XP color and duplex Doppler unit, using a 5.0/7.0 MHZ sector probe. Resistance index (RI = Peak systolic flow velocity - end diastolic flow velocity/peak systolic flow velocity) was calculated by a software program during 5 - 6 consecutive hemogeneous cardiac cycles; normal = RI of 0.5 to 0.8. There were 609 Doppler flow studies performed. The mean number of studies per patient was four. 98 of these neonates (BW 1329 ± 645g SD; GA 29.2± 3.8 wks SD) had at least one study with elevated RI. 53 infants had all normal RI (BW 1582 ± 785g SD; GA 31 ± 4.3 wks SD), and 3 had low RI. Infants with elevated RI had significantly more sepsis (30% vs 0% P<.002), and Intraventricular Hemorrhage (IVH) (34.6% vs 9.1, P<.03) than those with normal RI. There was no difference between high and normal RI in Patent Ductus Arterious (PDA) (72% vs 59%), Periventricular Leucomalacia(PVL) (7.9% vs 4.5%), apnea (72.4% vs 59.2%) or the need for inotrope therapy. All three infants with low RI had IVH and/or PVL. 14/151 patients died; 10/98 infants with elevated RI, 2/3 infants with low RI, and 1/51 infants with normal RI. So far, 58 patients have completed neurodevelopmental screening; suspicious developmental screening was found in 46.3% of elevated RI and 1.7% of normal RI patients. Summary: Elevated RI appears to correlate with sepsis and IVH, and may be associated with increased risk of developmental delay. Low RI, a sign of loss of autoregulation, may correlate with an increased risk of IVH, PVL, and death.

Long-term precision of glomerular filtration rate measurements using 51Cr-EDTA plasma clearance.

The long-term precision of chromium-51 ethylenediamine tetraacetic acid (51Cr-EDTA) measurements of glomerular filtration rate (GFR) was evaluated in a retrospective study of data obtained over a 12 year period. Each GFR measurement was derived from plasma samples taken at 2, 3 and 4 h following injection of 3 MBq 51Cr-EDTA. The records of 7507 patients were reviewed, from which 55 subjects were identified as having had studies on 10 or more occasions. The mean number of studies per patient was 12.9 (range 10-23) over a mean period of 9.4 years (range 4.3-11.8 years). Plots of GFR, clearance half-life, (T1/2) and volume of distribution (VD) were drawn for each patient and used to identify subjects showing linear changes with time that could be fitted using linear regression. Each residual was expressed as a percentage of the expected value calculated from the regression line and all the residuals combined to give histograms for GFR, T1/2 and VD. Each histogram was fitted with a normal distribution between the -3 S.D. and +3 S.D. limits using weighted least squares. Final results for the coefficient of variation were: GFR 9.8%, T1/2 6.7%, VD 9.4%. The precision errors were used to calculate the smallest statistically significant change measurable by the 51Cr-EDTA technique. With 10% significance and 80% power, the smallest measureable change was 30% for GFR and 20% for T1/2. Unless there are clinical grounds for thinking that a patient's volume of distribution has changed, T1/2 is the optimal parameter for identifying real changes in renal function.

Urologic problems in anorectal malformations. Part 1: Urodynamic findings and significance of sacral anomalies

A series of 90 children with anorectal malformations received a total of 163 urodynamic studies. The mean number of studies per patient was 1.8 (range, 1 to 7), and the mean age at the time of initial evaluation was 17 months (range, 1 to 128). Sacral anomalies were found in 38 children (42%); 30 of them had partial sacral agenesis and eight had sacral dysplasia without bony defect. Normal lower urinary tract function was found in 98% of the children who had a normal sacrum, in all children who had sacral dysplasia, and in a small number of those who had partial sacral agenesis that affected smaller parts of the S-4 and S-5 pedicles. Severe lower urinary tract dysfunction was observed in 22 patients (24%), all but one of whom had partial sacral agenesis. There was no correlation between the type of sacral agenesis and a specific urodynamic pattern. It is concluded that virtually all children with an anorectal malformation and associated sacral agenesis have neurogenic bladder-sphincter dysfunction and therefore should receive early urodynamic assessment and appropriate urologic treatment.