Triage Plan Research Articles

Association between peripheral venous catheter failure and care complexity factors in emergency department: a cross-sectional study

ObjectiveThe objective was to determine the prevalence of peripheral venous catheter (PVC) failure and its association with care complexity individual factors (CCIFs) in emergency department (ED) patients.DesignA cross-sectional, descriptive-correlational study...

The design and implementation of virtual reality simulations in Spanish for the Health Professions: what are learners’ perceptions?

Although virtual reality (VR) games and headsets are widely available and have started to be used in language courses, there is little previous research on how VR can be used in courses on Languages for Specific Purposes, particularly in Spanish for the Health Professions. The purpose of this study was to develop and implement VR simulations that mirrored a medical interview in Spanish and to examine learners’ attitudes toward language practice in a VR environment. Scenarios were designed following Task-Based Language Teaching and results from a language needs analysis. Participants in this study were undergraduate students enrolled in a Spanish for the Health Professions course. Participants took on the role of a healthcare provider to interact with Spanish-speaking avatars within the virtual environment. They completed a series of tasks relevant to the medical interview, including greetings, triage, symptom elicitation, social information, medication information, basic diagnosis, and treatment plan. They participated in surveys and wrote journals about their VR class experience. Results showed that the VR simulations contributed to perceived skill development with an emphasis on conversation, listening, critical thinking, and pronunciation. The immersive experience and real-world application led learners to be more engaged and focused while amplifying course topics, particularly cultural awareness and sensitivity, applied vocabulary, and pragmatics. Pedagogical implications are discussed.

Implementing a rapid cord compression Magnetic Resonance Imaging protocol in the emergency department: Lessons learned.

(1) Evaluate efficacy of an abbreviated total spine protocol in triaging emergency department (ED) patients through retrospective evaluation. (2) Describe patient outcomes following implementation of a rapid cord compression protocol. (1) All contrast-enhanced total spine magnetic resonance imaging studies (MRIs) performed on ED patients (n = 75) between 10/1-12/31/2022 for evaluation of cord compression were included. Two readers with 6 and 5years of experience blindly reviewed the abbreviated protocol (comprised of sagittal T2w and axial T2w sequences) assessing presence of cord compression or severe spinal canal stenosis. Ground truth was consensus by a neuroradiology fellow and 2 attendings. (2) The implemented rapid protocol included sagittal T1w, sagittal T2w Dixon and axial T2w images. All ED patients (n = 85) who were imaged using the rapid protocol from 5/1-8/31/2023 were included. Patient outcomes and call-back rates were determined through chart review. (1) Sensitivity and specificity for severe spinal canal stenosis and/or cord compression was 1.0 and 0.92, respectively, for reader 1 and 0.78 and 0.85, respectively, for reader 2. Negative predictive value was 1.0 and 0.97 for readers 1 and 2, respectively. (2) The implemented rapid cord compression protocol resulted in 60% reduction in imaging time at 1.5T. The call-back rate for additional sequences was 7%. In patients who underwent surgery, no additional MRI images were acquired in 82% of cases (9/11). Implementing an abbreviated non-contrast total spine protocol in the ED results in a low call-back rate with acquired MRI images proving sufficient for both triage and treatment planning in most patients.

'The Norm Is to Not Openly Collaborate': Using the Lens of Co-Production to Evaluate the Development of a COVID-19 ICU Triage Policy.

In 2020, surging cases of COVID-19 meant that health services had to plan for crisis-level triage. In the Australian Capital Territory, the Clinical Health Emergency Coordination Centre sought to develop a triage policy in collaboration with a range of consumer, carer and community groups. This study aims to map the collaborative development of the COVID-19 ICU triage policy onto the principles of co-production. Interviews were conducted with facilitators, members of advocacy or consumer groups and clinicians who were involved in the development of the triage policy. Interviews were thematically analysed using both theory- and data-driven approaches to, respectively, draw on the theoretical framework of co-production, and to explore participants' perspectives relevant to but beyond the scope of this theoretical framework. The findings suggest that at each stage of the initiative, there were ways in which the principles of co-production were met, and ways in which they were not met. One of the fundamental concerns that arose was about whether trying to solve a problem based on resources was compatible with a solution based on human rights. Literature about co-production has been critiqued for being limited to aspirational concerns, or implying co-production is easily achievable. The current study contributes to existing research through the application of the theoretical framework of co-production and exploring ways its aims were met and not met within a system-level collaboration developing a high-stakes health policy. This study has been conducted and written by researchers working from lived experience perspectives, and other researchers working from traditionally mainstream health disciplines, including psychology and medicine. Further, the study is about patient and public involvement in the development of a health policy. Thus it both embodies and is about non-tokenistic collaboration between people with lived experience and other health professionals.

Evaluation of musculoskeletal system injuries after the 2023 Kahramanmaraş Turkey earthquakes: Our single-center experience.

This study aimed to retrospectively analyze patients who presented to the orthopedic and traumatology clinic following the 2023 Kahramanmaraş earthquakes. Over a week after the earthquakes, two hundred and sixty patients were consulted at our clinic. Demographic data of the patients, duration of being under the rubble, fracture locations, types of surgeries performed, number of surgical sessions attended by individuals, and early mortality rate within one month were determined. The mean age of the patients was 40.2 ± 22.4 years. One hundred thirty-eight (53.1%) were female, and 122 (46.9%) were male. The average duration of being under the rubble was determined as 27.1 ± 28.0 hours. Sixteen patients died within one month after the earthquake. The one-month mortality rate among patients with orthopedic injuries was 6.15%. Forty-seven fasciotomies were performed in 35 patients, and 22 amputations were performed in 19 patients. The most injured region was the lower extremity (78 cases, 40%). The ratio of external and internal fixation in extremity fractures was 22%. The management of musculoskeletal injuries can be successful with proper triage and treatment plans. Decisions regarding fasciotomy and amputation in patients with crush syndrome following an earthquake should be individualized. Implant sets should be planned accordingly, especially considering the higher occurrence of lower extremity injuries.

0977 A Non-Pharmacological Insomnia Treatment for Suicidal Behavior in High-Risk Civilians: An Open-Label Clinical Trial

Abstract Introduction Suicide has emerged as a public health crisis, where interventions remain scarce, unacceptable, and inaccessible to those high in need. By comparison, poor sleep is non-stigmatizing, visible, and highly treatable as a risk factor and transdiagnostic intervention target in suicide prevention. Aim 1: To develop, manualize, and test feasibility of a sleep-oriented treatment for suicidal behaviors within an open label clinical trial. Aim 2: To test antisuicidal response and indications of efficacy posttreatment across primary (suicidal ideation), secondary (sleep indices), and exploratory (mood indices) outcomes. Methods A multicomponent selective treatment was developed integrating: CBT for Insomnia (CBTi), Imagery Rehearsal Treatment (IRT), and Social Rythyms Treatment (SRT) (to address insomnia, nightmares, sleep variability) within an abbreviated (5-session) format (iSleep: Insomnia Treatment for Improved Well-Being). Treatment was manualized across session-by-session materials (powerpoints, homework, therapist guidesheets). Participants were enrolled based on screening and inclusion criteria: (a) age >18, (b) clinically-significant sleep disturbance (Insomnia Severity Index (ISI>10)); Pittsburgh Sleep Quality Index (PSQI>5)), (c) DSM-V-Defined Major Depressive Disorder, (d) current suicidal ideation (Columbia Suicidal Severity Rating Scale (CSSRS>1)). Comprehensive data and safety monitoring procedures were used to support risk assessment, triage, and outpatient safety planning. Outcomes were assessed at Baseline, Treatment, and Posttreatment (1,3 mos) timepoints. Results Of n=590 new contacts, n=310 participants were screened for high suicide risk. Fifty-nine participants were interviewed by full-battery eligibility assessment, resulting in n=35 participants enrolled for treatment allocation. Feasibility analyses demonstrated high rates of acceptance, tolerability, and safety. Paired t-tests revealed large posttreatment reductions in suicidal ideation (CSSRS, p<.001), in addition to secondary outcomes of sleep disturbance (ISI, p<.001; DDNSI, p<.001) and depression (QIDS-SR, p<.001). Effects were large and sustained through study follow up. Conclusion A non-pharmacological insomnia intervention (iSleep Treatment) resulted in antisuicidal symptom response and posttreatment improvements in sleep and overall well-being. Effects were large and observed across primary, secondary, and exploratory outcomes. This is the first known report testing use of a newly-developed, multicomponent insomnia treatment within an open label suicide prevention clinical trial, demonstrating excellent feasibility, safety, and therapeutic impact to suicidal risk. Support (if any) Work was supported by NIH (K23MH093490) and DOD/MOMRP/MSRC funding (W81XWH-10-2-0178)

Factors Influencing Triage to Rehabilitation in Functional Movement Disorder.

Treatment of functional movement disorder (FMD) should be individualized, yet factors determining rehabilitation engagement have not been evaluated. Subspecialty FMD clinics are uniquely poised to explore factors influencing treatment suitability and triage. To describe our approach and explore factors associated with triage to FMD rehabilitation. We conducted a retrospective chart review of 158 consecutive patients with FMD seen for integrated assessment by movement disorders neurology and psychiatry, with the purpose of triage to rehabilitation. Demographic and clinical variables were compared between patients triaged to therapy versus no therapy, and logistic regression was used to explore factors predictive of triage outcome. Change in primary outcome scores were analyzed. Sixty-six patients (42%) were triaged to FMD therapy from July 2019 to December 2021. Patients triaged to therapy were more likely to have a constant movement disorder, gait disorder and/or tremor, hyperarousal, readiness for change, and people pleasing traits. Patients triaged to no therapy demonstrated persistent diagnostic disagreement, an inability to appreciate motor symptom inconsistency, low self-agency, a propensity to dissociate, and cluster B traits. 90% of patients triaged to rehabilitation had improved outcomes. The ability to "opt-in" to FMD rehabilitation relies on different factors than those relevant to establishing a diagnosis. Unlike many other neurological disorders, a triage and treatment planning step is recommended to identify those likely to meaningfully engage at that time. Holistic assessment through a transdisciplinary lens, and working collaboratively with the patient is essential to prioritize symptoms, determine engagement, and identify treatment targets.

Abstract WMP40: A Geospatial Information Services Assessment of Prehospital Bypass on Overtriage for Large Vessel Occlusion and Hemorrhagic Stroke

Introduction: To increase the number of patients with large vessel occlusion (LVO) acute ischemic strokes (AIS) transported directly to Comprehensive Stroke Centers (CSCs), on December 1, 2021, the threshold score for our county EMS agency’s quantitative stroke severity scale (FAST-ED) for bypassing a non-CSC decreased from 7 to 6. The goal of this work was to evaluate the impact of and adherence to this change, and its effect on overtriage. Methods: Two large regional health systems and the county EMS agency collaborated on this study. Using latitude and longitude coordinates from our EMS agency’s database, we geocoded the pick-up location of all patients who had a FAST-ED score of ≥6 from September 2019 to December 2022. We used ArcGIS to calculate drive times to the closest facility among 2 CSCs and 7 non-CSCs, and linked EMS records to hospital records to determine LVO AIS involving the intracranial ICA, M1, M2 or basilar artery. For patients without a CSC as the closest destination facility, we defined overtriage as routing to a CSC for a non-LVO or non-hemorrhagic stroke patient. Results: Over our 40-month study period, among patients with a FAST-ED score performed (n=13,913), 824 had a score ≥6. Actual versus ArcGIS drive times in minutes [mean(SD)] compared favorably [14.8(8.5) vs 14.4(6.4), with an ICC of 0.68 (95% CI 0.64-0.72). For 799/824 patients (97%), one of the county’s two CSCs was not the closest destination facility, and among this group 99% (n=787/799) of EMS records were successfully linked to the hospital record. Among these patients, prior to December 1, 2021, 67% (n=219/326) patients with FAST-ED score ≥7 were bypassed to a CSC, with an overtriage rate of 49% (n=107/219), while after that date 88% (n=230/262) patients with a FAST-ED score ≥6 were bypassed to a CSC, with an overtriage rate of 55% (n=126/230). Conclusion: It is feasible to use drive times calculated from ArcGIS to evaluate the performance of EMS stroke triage and destination plans. Lowering our county’s FAST-ED score threshold for bypass increased adherence to the bypass protocol with a modest increase in overtriage. Future work will incorporate undertriage rates with the ultimate goal of optimizing our regional stroke and triage destination plan.

Principles for delivering improved care of people with functional seizures: Closing the treatment gap.

Patients diagnosed with functional (psychogenic nonepileptic) seizures have similar or greater levels of disability, morbidity and mortality than people with epilepsy, but there are far fewer treatment services. In contrast to epilepsy, the current understanding of pathophysiological mechanisms and the development of evidence-based treatments for functional seizures is rudimentary. This leads to high direct healthcare costs and high indirect costs to the patient, family and wider society. There are many patient, clinician and system-level barriers to improving outcomes for functional seizures. At a patient level, these include the heterogeneity of symptoms, diagnostic uncertainty, family factors and difficulty in perceiving psychological aspects of illness and potential benefits of treatment. Clinician-level barriers include sub-specialism, poor knowledge, skills and attitudes and stigma. System-level barriers include the siloed nature of healthcare, the high prevalence of functional seizures and funding models relying on individual medical practitioners. Through the examination of international examples and expert recommendations, several themes emerge that may address some of these barriers. These include (1) stepped care with low-level, brief generalised interventions, proceeding to higher level, extended and individualised treatments; (2) active triage of complexity, acuity and treatment readiness; (3) integrated interdisciplinary teams that individualise formulation, triage, and treatment planning and (4) shared care with primary, emergency and community providers and secondary consultation. Consideration of the application of these principles to the Australian and New Zealand context is proposed as a significant opportunity to meet an urgent need.

How useful is pre-referral pediatric spine imaging?

PurposePrimary care physicians rely on radiology reports to confirm a scoliosis diagnosis and inform the need for spine specialist referral. In turn, spine specialists use these reports for triage decisions and planning of care. The objectives were to determine (1) the adequacy of index images to inform treatment decisions at the initial consultation and (2) the utility of index radiology reports for appropriate triage decisions.MethodsA retrospective chart review was conducted including all idiopathic scoliosis patients seen for initial consultation, aged three to 18 years, between January 1 and April 30, 2021. A score out of five was generated based on the adequacy of index images to provide accurate Cobb angle measurements and determine skeletal maturity. Index images were considered inadequate if repeat imaging was necessary. Index radiology reports, associated imaging, and new imaging, if obtained at the initial consultation, were compared.ResultsOf the 94 patients reviewed, 79% (n = 74) required repeat imaging at the initial consultation, of which 74% (n = 55) were due to insufficient quality and/or limited field of view. Of index images available for review at the initial consult (n = 80), 41.2% scored five out of five, and 32.5% scored two or below. Comparing index radiology reports to initial visit evaluation with ≤ 60 days between imaging (n = 49), discrepancies in Cobb angle were found in 24.5% (95% CI 14.6, 38.1) of patients. The Risser stage was reported in 14% of index radiology reports.ConclusionAlthough pre-referral pediatric spine radiographs serve a diagnostic purpose, most are inadequate for comprehensive idiopathic scoliosis evaluation.Level of evidenceIII.

Less is more - The Finnish Prehospital Stroke Scale prospective validation

The current bifurcation of the acute stroke care pathway requires prehospital separation of strokes caused by large vessel occlusion. The first four binary items of the Finnish Prehospital Stroke Scale (FPSS) identify stroke in general, while the fifth binary item alone identifies stroke due to large vessel occlusion. The straightforward design is both easy for paramedics and statistically beneficial. We implemented FPSS based Western Finland Stroke Triage Plan, including medical districts of a comprehensive stroke center and four primary stroke centers. The prospective study population was consecutive recanalization candidates transported to the comprehensive stroke center within the first six months of implementing the stroke triage plan. Cohort 1 consisted of n=302 thrombolysis- or endovascular treatment candidates transported from the comprehensive stroke center hospital district. Cohort 2 comprised ten endovascular treatment candidates transferred directly to the comprehensive stroke center from the medical districts of four primary stroke centers. In Cohort 1, FPSS sensitivity for large vessel occlusion was 0.66, specificity 0.94, positive predictive value 0.70, and negative predictive value 0.93. Of the ten Cohort 2 patients, nine had large vessel occlusion, and one had an intracerebral hemorrhage. FPSS is straightforward enough to be implemented in primary care services to identify candidates for endovascular treatment and thrombolysis. When used by paramedics, it predicted two-thirds of large vessel occlusions with the highest specificity and positive predictive value reported to date.

A call for nail clipping histopathology to become an essential component of the routine evaluation of melanonychia: Benefitting patients as a triage and surgical planning maneuver.

We call on dermatologists and dermatopathologists to include nail clipping histopathology as an essential component of the routine evaluation of melanonychia. This manuscript demonstrates a case where an adult woman with broad melanonychia of the right thumbnail declined a nail matrix biopsy, but was amenable to a nail clipping.The nail clipping showed pigmentation, melanocyte remnants, and small cavities in the nail plate. These features have been published previously by our group as a clue to nail unit melanoma within nail clippings.This patient was rapidly triaged for nail matrix biopsy, which demonstrated nail unit melanoma in situ. Every patient with melanonychia can benefit from a nail clipping by examination of the location of the pigmentation within the nail plate for surgical planning, and if melanocyte remnants are detected, the nail clipping also serves as a rapid triage mechanism for nail matrix biopsy to evaluate for nail unit melanoma. Fontana-stained sections will highlight the pigmentation in the nail plate, and its location in the nail plate can easily be described by the dermatopathologist. Nail clippings performed in the setting of clinically apparent melanonychia may show helpful histopathologic findings of pigmented fungi, hemorrhage, external pigmentation, features of other pigmented nail unit tumors, as well as other entities. Nail clipping histopathology can provide extensive information in the evaluation of melanonychia with minimal discomfort for a patient, and little disruption to a physician's clinic flow. With this additional case of a nail unit melanoma diagnosed after initial concern found in a nail clipping, as well as other information in the literature, it is clear that melanocyte remnants found in nail clippings are reliable concerning features related to nail unit melanoma in adults. With knowledge of these histopathologic features in nail clippings and the significance of melanocyte remnants, the dermatopathologist can play a crucial role in the use of a nail clipping as a life-saving diagnostic maneuver. Accordingly, given the potential benefit to patients in this setting, as well as other uses of a nail clipping in the evaluation of melanonychia, we call on dermatologists and dermatopathologists to innovate the routine evaluation of melanonychia through the routine employment of nail clippings for histopathologic evaluation.

Use of infection biomarkers in the emergency department.

The use of infection biomarkers in the emergency department is discussed in terms of their possible contributions to diagnostic-prognostic uncertainties, appropriate antibiotic treatments, and triage and follow-up planning. Procalcitonin (PCT), C-reactive protein (CRP), proadrenomedullin (proADM), and presepsin are among the most discussed infection biomarkers for use in the emergency department. Due to the variable sensitivity results and cutoff values, there are insufficient data to recommend the widespread use of CRP and procalcitonin (PCT) for the diagnosis and prognosis of infection in the emergency department. However, these biomarkers can be used for appropriate antibiotic use in selected infection groups, such as community-acquired pneumonia, especially to reduce unnecessary antibiotic prescribing. With its prognostic superiority over other biomarkers and its contribution to prognostic score systems in community-acquired pneumonia (CAP), proADM can be used to predict hospitalization, preferably within the scope of clinical studies. Although presepsin has been shown to have some advantages over other biomarkers to rule out sepsis, there are insufficient data for its clinical use in the emergency department.

Real-world diagnostic value of a nationwide standardized COVID-19 triage chart in Turkey.

Effective triage is critical during the coronavirus disease 2019 (COVID-19) pandemic. An appropriate triage plan is crucial to direct suspected COVID-19 cases to a designated area, in order to separate such patients from other patients and staff. To report the diagnostic value of the "Possible Coronavirus Disease 2019 (COVID-19) Case Questioning Guide for Outpatients", a nationwide standard triage chart, and of the individual questions within the triage chart for detecting COVID-19 in patients admitted to our hospital. A total of 39,681 outpatients admitted to our hospital between April 1 and April 30, 2021, underwent triage questioning. The triage chart consisted of 3 symptom questions and 4 contact and travel questions. Patients who responded "yes" to at least 1 question were referred to the pandemic area; others were considered low-risk and did not undergo routine COVID-19 polymerase chain reaction (PCR) test. Briefly, 3529 outpatients were referred to the pandemic area; among them, 1055 were PCR-positive. Among 36,152 low-risk patients, 94 were PCR-positive. The sensitivity of the triage chart was 91.82%, specificity was 93.58%, positive likelihood ratio was 14.30, and negative likelihood ratio was 0.09. Triage questions were in moderate agreement with PCR results (Cohen's Kappa: 0.429, p < 0.0001). The diagnostic value of the triage chart was mainly attributed to the questions regarding possible COVID-19 infection symptoms rather than contact history. However, the questions included in the triage chart had none to slight agreement with the PCR test results in the pandemic outpatients. The triage chart has high sensitivity and specificity for discriminating possible COVID-19 cases in all outpatients, but has unsatisfactory diagnostic value for predicting PCR positivity in pandemic outpatients. Therefore, the current triage chart should be used accordingly, i.e., to define possible COVID-19 cases rather than PCR-positive cases. Further studies regarding COVID-19 triage for possible and PCR-positive cases should also focus on the individual diagnostic value of less prevalent symptoms.

COVID-19 and algorithmic medical ethics: A Christian perspective

Triage plans which were largely developed in the face of the growing and lethal pandemic betrayed an underlying anthropology which unintentionally neglected to allow for the assignment of potentially limited interventions to underserved and less socially advantaged persons. This neglect is abetted by the structure of US medical delivery that treats medical care as a commercial commodity with an emphasis on high tech rescue medicine as opposed to preventive public health medicine. A Christian anthropology modeled by Karl Barth’s notion of analogia relationis would correct this neglect of the underserved and needy.

Identification of Seniors at Risk Scoring in Geriatric Trauma: Exploring Clinical Outcome Correlations.

Introduction:Geriatric trauma patients (GTP) make up an increasing percentage of the overall trauma population. Due to frailty, GTP are at an increased risk of morbidity and readmission. Therefore, it is becoming increasingly important to prognosticate outcomes to assist with resource utilization. We hypothesized that the “Identification of Seniors at Risk” (ISAR) score may correlate with both clinical outcomes and resource utilization for geriatric trauma patients.Methods:Patients older than 65 years who were admitted to the trauma service were screened using an ISAR scoring algorithm. Outcomes, including 30-day mortality, all-cause morbidity, hospital length of stay (LOS), intensive care unit (ICU) LOS, functional independence measures (FIM) at discharge, and percent discharged to a facility, were analyzed. Both descriptive and data-appropriate parametric and non-parametric statistical approaches were utilized, with significance set at α = 0.05.Results:One thousand and two hundred seventeen GTP were included in this study. The average age was 81, median injury severity score was 9, and 99% had a blunt trauma mechanism. ISAR scores were generally associated with increasing 30-day mortality (0%, 1.9%, 2.4%, and 2.1% for ISAR 0, ISAR 1–2, ISAR 3–4, and ISAR 5–6, respectively), morbidity (2.6%, 7.6%, 14.7%, and 7.3% for respective categories), longer hospital (3.1, 4.6, 5.1, and 4.3 days, respectively) and ICU stays (0.37, 0.64, 0.81, and 0.67, respectively), lower FIM score at discharge (18.5, 17.1, 15.8, and 14.4, for respective categories), as well as increasing percentage of patients discharged to a facility (29.8%, 58.9%, 72.1%, and 78.8% for respective categories).Conclusions:This exploratory study provides important early insight into potential relationships between ISAR and geriatric trauma outcomes. ISAR screening is a quick and easy-to-use tool that may be useful in GTP triage, level-of-care determination, and disposition planning. Understanding populations at risk, especially those with more intricate discharge needs, is an important step in mitigating those risks and implementing appropriate care plans.

Transitional and Long-Term Rehabilitation Care System After Stroke in Korea.

Stroke is one of the leading causes of mortality and disability in Korea. Patients who experience stroke require adequate management throughout the acute to subacute and chronic stages. Many patients with long-term functional issues require rehabilitative management even in the chronic stage. A comprehensive rehabilitation and care model for patients who experience stroke is necessary to effectively manage their needs during rehabilitation and allocate medical resources throughout the stages, thus ensuring reduced unmet needs and improved post-stroke quality of life. In Korea, the government and medical specialists are working on re-organizing the rehabilitation care model, including standardized triage and discharge planning after acute stroke treatment, and establishing systematic transitional and long-term rehabilitation care plans. This review briefly introduces the general rehabilitation triage after acute stroke and describes the current transitional and continuous care systems available for these patients in Korea. We also present the issues faced in transitional and long-term care plans of the current system and the efforts invested in resolving them and promoting long-term care in stroke cases.

Edge-enhanced dual discriminator generative adversarial network for fast MRI with parallel imaging using multi-view information

In clinical medicine, magnetic resonance imaging (MRI) is one of the most important tools for diagnosis, triage, prognosis, and treatment planning. However, MRI suffers from an inherent slow data acquisition process because data is collected sequentially in k-space. In recent years, most MRI reconstruction methods proposed in the literature focus on holistic image reconstruction rather than enhancing the edge information. This work steps aside this general trend by elaborating on the enhancement of edge information. Specifically, we introduce a novel parallel imaging coupled dual discriminator generative adversarial network (PIDD-GAN) for fast multi-channel MRI reconstruction by incorporating multi-view information. The dual discriminator design aims to improve the edge information in MRI reconstruction. One discriminator is used for holistic image reconstruction, whereas the other one is responsible for enhancing edge information. An improved U-Net with local and global residual learning is proposed for the generator. Frequency channel attention blocks (FCA Blocks) are embedded in the generator for incorporating attention mechanisms. Content loss is introduced to train the generator for better reconstruction quality. We performed comprehensive experiments on Calgary-Campinas public brain MR dataset and compared our method with state-of-the-art MRI reconstruction methods. Ablation studies of residual learning were conducted on the MICCAI13 dataset to validate the proposed modules. Results show that our PIDD-GAN provides high-quality reconstructed MR images, with well-preserved edge information. The time of single-image reconstruction is below 5ms, which meets the demand of faster processing.

COVID-19 pandemic: the impact on Canada’s intensive care units

The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.

The Long-Term Efficacy of Conventional Treatments for Bynesian Decay

Abstract The efficacy of the conventional method for treating Bynesian decay (formerly known as Byne’s disease) is assessed via a review of the outcomes of two remediation projects after 10 and 22 years. The design and implementation of a large-scale triage plan for an incoming collection is described, and the limitations of diagnostic methods for this form of decay are discussed. Examples of arrested and ongoing decay are illustrated.