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pubmed: Quality of care



NCBI: db=pubmed; Term=(("quality assurance, health care"[MeSH Terms] OR "quality indicators, health care"[MeSH Terms] OR "quality of health care"[MeSH Terms] OR "total quality management"[MeSH Terms]) AND quality[TI]) AND English[Lang] AND "adult"[MeSH Te



 



Association of Changes in Diet Quality with Total and Cause-Specific Mortality.
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Association of Changes in Diet Quality with Total and Cause-Specific Mortality.

N Engl J Med. 2017 07 13;377(2):143-153

Authors: Sotos-Prieto M, Bhupathiraju SN, Mattei J, Fung TT, Li Y, Pan A, Willett WC, Rimm EB, Hu FB

Abstract
BACKGROUND: Few studies have evaluated the relationship between changes in diet quality over time and the risk of death.
METHODS: We used Cox proportional-hazards models to calculate adjusted hazard ratios for total and cause-specific mortality among 47,994 women in the Nurses' Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986-1998) were assessed with the use of the Alternate Healthy Eating Index-2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score.
RESULTS: The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower - by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score - than the risk among participants with consistently low diet scores over time.
CONCLUSIONS: Improved diet quality over 12 years was consistently associated with a decreased risk of death. (Funded by the National Institutes of Health.).

PMID: 28700845 [PubMed - indexed for MEDLINE]




Traumatic Brain Injury, Sleep Quality, and Suicidal Ideation in Iraq/Afghanistan Era Veterans.
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Traumatic Brain Injury, Sleep Quality, and Suicidal Ideation in Iraq/Afghanistan Era Veterans.

J Nerv Ment Dis. 2017 Jul;205(7):512-516

Authors: DeBeer BB, Kimbrel NA, Mendoza C, Davidson D, Meyer EC, La Bash H, Gulliver SB, Morissette SB

Abstract
The objective of this study was to test the hypothesis that sleep quality mediates the association between traumatic brain injury (TBI) history and current suicidal ideation. Measures of TBI history, sleep quality, and suicidal ideation were administered to 130 Iraq/Afghanistan veterans. As expected, sleep quality mediated the effect of TBI history on current suicidal ideation (indirect effect, 0.0082; 95% confidence interval, 0.0019-0.0196), such that history of TBI was associated with worse sleep quality, which was, in turn, associated with increased suicidal ideation. These findings highlight the importance of assessing TBI history and sleep quality during suicide risk assessments for veterans.

PMID: 28590264 [PubMed - indexed for MEDLINE]




Fat Suppressed Contrast-Enhanced T1-Weighted Dynamic Magnetic Resonance Imaging at 3T: Comparison of Image Quality Between Spectrally Adiabatic Iversion Recovery and the Multiecho Dixon Technique in Imaging of the Prostate.
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Fat Suppressed Contrast-Enhanced T1-Weighted Dynamic Magnetic Resonance Imaging at 3T: Comparison of Image Quality Between Spectrally Adiabatic Iversion Recovery and the Multiecho Dixon Technique in Imaging of the Prostate.

J Comput Assist Tomogr. 2017 May/Jun;41(3):382-387

Authors: Iyama Y, Nakaura T, Kidoh M, Katahira K, Namimoto T, Morishita S, Yamashita Y

Abstract
OBJECTIVE: To compare the quality of fat suppression and image quality between multiecho Dixon technique (mDixon) and spectrally adiabatic iversion recovery (SPAIR) in dynamic contrast-enhanced magnetic resonance imaging of the prostate.
METHODS: This prospective study assigned thirty consecutive patients to scanning with SPAIR technique (SPAIR protocol) and another consecutive 30 patients to scanning with mDixon technique (mDixon protocol). We calculated the contrast, signal to noise ratio (SNR), contrast to noise ratio (CNR) and the coefficient of variation between the 2 protocols. Two readers compared homogeneity of fat suppression, image noise, image contrast, and image sharpness between the two protocols.
RESULTS: The SNR, CNR, and contrast of mDixon protocol were significantly higher than those of the SPAIR protocol (SNR: 14.7 ± 4.1 vs 11.0 ± 2.6; P < 0.05; CNR: 6.3 ± 1.6 vs 0.5 ± 1.5; P < 0.01; contrast: 4.4 ± 1.4 vs 1.3 ± 0.5; P < 0.01), whereas the coefficient of variation of mDixon protocol was significantly lower than that of SPAIR protocol (34.7 ± 15.5 vs 43.7 ± 23.1, P < 0.01). In qualitative image analysis, the image scores for the homogeneity of fat suppression, image noise, and image sharpness were significantly higher with mDixon protocol than those with SPAIR protocol (P < 0.01). There was no significant difference in image contrast between 2 fat suppression protocols (P > 0.05).
CONCLUSIONS: In dynamic contrast-enhanced magnetic resonance imaging of the prostate, mDixon technique improved the homogeneity of fat suppression without degrade of image quality compared with SPAIR technique.

PMID: 28505622 [PubMed - indexed for MEDLINE]




Relationship Quality and Distress in Caregivers of Persons With Dementia: A Cross-Sectional Study.
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Relationship Quality and Distress in Caregivers of Persons With Dementia: A Cross-Sectional Study.

Am J Alzheimers Dis Other Demen. 2017 May;32(3):157-165

Authors: Bjørge H, Kvaal K, Småstuen MC, Ulstein I

Abstract
This cross-sectional study aimed to investigate the relationship between caregivers and care receivers, defined as home-dwelling family members with dementia. We used a self-rating questionnaire, the Felt Expressed Emotion Rating Scale (FEERS; 6 simple questions), to measure caregiver perceptions of the care receiver's criticisms (CCs) and emotional overinvolvement (EOI) toward the caregiver. We performed factor analyses to rank single items on the FEERS pertaining to CC and EOI. We included 208 caregiver/care receiver pairs. Logistic regression analyses tested associations between FEERS items and caregiver and care receiver variables. The main contributors to caregiver perceptions of CC were the caregiver's own distress and the amount of time spent with the care receiver. Socially distressed caregivers perceived the care receiver as emotionally overinvolved. When offering a psychosocial intervention, a tailored program should target the caregiver's perceived relationship with the family member and the caregiver's distress. The program should also endeavor to give the caretaker more opportunities for leisure time.

PMID: 28423936 [PubMed - indexed for MEDLINE]




Associations between motives for dish choice during home-meal preparation and diet quality in French adults: findings from the NutriNet-Santé study.
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Associations between motives for dish choice during home-meal preparation and diet quality in French adults: findings from the NutriNet-Santé study.

Br J Nutr. 2017 Mar;117(6):851-861

Authors: Ducrot P, Méjean C, Fassier P, Allès B, Hercberg S, Péneau S

Abstract
A number of motives such as constraints or pleasure have been suggested to influence dish choices during home-meal preparation. However, no study has evaluated how the importance conferred to these motives potentially influence diet quality. The present study aims at investigating the difference in diet quality according to the importance attached by individuals to various dish choice motives. The importance of twenty-seven criteria related to dish choices on weekdays was evaluated among 48 010 French adults from the NutriNet-Santé study. ANCOVA and logistic regression models, adjusted for sociodemographic and lifestyle factors, were used to evaluate the association between the importance attached to dish choice motives (yes v. no) and energy and food group intakes, as well as adherence to French nutritional guidelines (modified Programme National Nutrition Santé-Guideline Score (mPNNS-GS)). A higher adherence to nutritional guidelines was observed in individuals attaching importance to a healthy diet (mPNNS-GS score 7·87 (sd 0·09) v. 7·39 (sd 0·09)) and specific diets (mPNNS-GS score 7·73 (sd 0·09) v. 7·53 (sd 0·09)), compared with those who attached little/no importance (all P<0·0001). These individuals also exhibited higher intakes of fruits and vegetables, but a lower consumption of meat, milk and cheese, sugary products and convenience foods compared with their respective counterparts (all P<0·0001). For other motives, that is, constraints, pleasure and organisation, only small differences were observed. The main difference in diet quality was related to the importance placed on a healthy diet. Although a causal link should be demonstrated, our findings suggested that strategies aiming at enabling people to take into account diet quality during home-meal preparation might be effective levers to promote healthy eating.

PMID: 28393743 [PubMed - indexed for MEDLINE]




The Michigan Trauma Quality Improvement Program: Results from a collaborative quality initiative.
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The Michigan Trauma Quality Improvement Program: Results from a collaborative quality initiative.

J Trauma Acute Care Surg. 2017 May;82(5):867-876

Authors: Hemmila MR, Jakubus JL, Cain-Nielsen AH, Kepros JP, Vander Kolk WE, Wahl WL, Mikhail JN

Abstract
BACKGROUND: American College of Surgeons verified trauma centers and a third-party payer within the state of Michigan built a regional collaborative quality initiative (CQI). The Michigan Trauma Quality Improvement Program began as a pilot in 2008 and expanded to a formal program in 2011. Here, we examine the performance of the collaborative over time with regard to patient outcomes, resource utilization, and process measures.
METHODS: Data from the initial 23 hospitals that joined the CQI in 2011 were analyzed. Performance trends from 2011 to 2015 were evaluated for outcomes, resource utilization, and process measures using univariate analysis. Risk-adjustment was performed to confirm results observed in the unadjusted data. To calculate the potential number of patients impacted by the CQI program, the maximum absolute change was multiplied by the number of trauma patients treated in the 23 hospitals during 2015.
RESULTS: Membership in a CQI program significantly reduced serious complications (8.5 vs. 7.3%, p = 0.002), decreased resource utilization, and improved process measure execution in trauma patients over 5 years time. Similar results were obtained in unadjusted and risk-adjusted analyses. The CQI program potentially avoided inferior vena cava filter placement in 167 patients annually. Decreased venous thromboembolism rates mirrored increased compliance with venous thromboembolism pharmacologic prophylaxis.
CONCLUSION: This study confirms our hypothesis that participation in a regional CQI improves patient outcomes and decreases resource utilization while promoting compliance with processes of care.
LEVEL OF EVIDENCE: Economic/therapeutic care, level V.

PMID: 28301397 [PubMed - indexed for MEDLINE]




Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial.
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Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial.

Anesth Analg. 2017 Feb;124(2):560-569

Authors: Chau A, Bibbo C, Huang CC, Elterman KG, Cappiello EC, Robinson JN, Tsen LC

Abstract
BACKGROUND: The dural puncture epidural (DPE) technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. The DPE technique has been shown to improve caudal spread of analgesia compared with epidural (EPL) technique without the side effects observed with the CSE technique. We hypothesized that the onset of labor analgesia would follow this order: CSE > DPE > EPL techniques.
METHODS: A total of 120 parturients in early labor were randomly assigned to EPL, DPE, or CSE groups. Initial dosing for EPL and DPE consisted of epidural 20 mL of 0.125% bupivacaine plus fentanyl 2 μg/mL over 5 minutes, and for CSE, intrathecal 0.25% bupivacaine 1.7 mg and fentanyl 17 μg. Upon block completion, a blinded coinvestigator assessed the outcomes. Two blinded obstetricians retrospectively interpreted uterine contractions and fetal heart rate tracings 1 hour before and after the neuraxial technique. The primary outcome was time to numeric pain rating scale (NPRS) ≤ 1 analyzed by using Kaplan-Meier curves and Cox proportional hazard model. Secondary outcomes included block quality, maternal adverse effects, uterine contraction patterns, and fetal outcomes analyzed by using the χ test with Yates continuity correction.
RESULTS: There was no significant difference in the time to NPRS ≤ 1 between DPE and EPL (hazard ratio 1.4; 95% confidence interval [CI] 0.83-2.4, P = .21). DPE achieved NPRS ≤ 1 significantly slower than CSE (hazard ratio 0.36; 95% CI 0.22-0.59, P = .0001). The median times (interquartile range) to NPRS ≤ 1 were 2 (0.5-6) minutes for CSE, 11 (4-120) minutes for DPE, and 18 (10-120) minutes for EPL. Compared with EPL, DPE had significantly greater incidence of bilateral S2 blockade at 10 minutes (risk ratio [RR] 2.13; 95% CI 1.39-3.28; P < .001), 20 minutes (RR 1.60; 95% CI 1.26-2.03; P < .001), and 30 minutes (RR 1.18; 95% CI 1.01-1.30; P < .034), a lower incidence of asymmetric block after 30 minutes (RR 0.19; 95% CI 0.07-0.51; P < .001) and physician top-up intervention (RR 0.45; 95% CI 0.23-0.86; P = .011). Compared with CSE, DPE had a significantly lower incidence of pruritus (RR 0.15; 95% CI 0.06-0.38; P < .001), hypotension (RR 0.38; 95% CI 0.15-0.98; P = .032), combined uterine tachysystole and hypertonus (RR 0.22; 95% CI 0.08-0.60; P < .001), and physician top-up intervention (RR 0.45; 95% CI 0.23-0.86; p = .011).
CONCLUSIONS: Analgesia onset was most rapid with CSE with no difference between DPE and EPL techniques. The DPE technique has improved block quality over the EPL technique with fewer maternal and fetal side effects than the CSE technique for parturients requesting early labor analgesia.

PMID: 28067707 [PubMed - indexed for MEDLINE]




Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database.
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Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database.

J Surg Res. 2017 Jan;207:205-214

Authors: Sutton E, Miyagaki H, Bellini G, Shantha Kumara HM, Yan X, Howe B, Feigel A, Whelan RL

Abstract
BACKGROUND: Superficial surgical site infection (sSSI) is one of the most common complications after colorectal resection. The goal of this study was to determine the comorbidities and operative characteristics that place patients at risk for sSSI in patients who underwent rectal cancer resection.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried (via diagnosis and Current Procedural Terminology codes) for patients with rectal cancer who underwent elective resection between 2005 and 2012. Patients for whom data concerning 27 demographic factors, comorbidities, and operative characteristics were available were eligible. A univariate and multivariate analysis was performed to identify possible risk factors for sSSI.
RESULTS: A total of 8880 patients met the entry criteria and were included. sSSIs were diagnosed in 861 (9.7%) patients. Univariate analysis found 14 patients statistically significant risk factors for sSSI. Multivariate analysis revealed the following risk factors: male gender, body mass index (BMI) >30, current smoking, history of chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists III/IV, abdominoperineal resection (APR), stoma formation, open surgery (versus laparoscopic), and operative time >217 min. The greatest difference in sSSI rates was noted in patients with COPD (18.9 versus 9.5%). Of note, 54.2% of sSSIs was noted after hospital discharge. With regard to the timing of presentation, univariate analysis revealed a statistically significant delay in sSSI presentation in patients with the following factors and/or characteristics: BMI <30, previous radiation therapy (RT), APR, minimally invasive surgery, and stoma formation. Multivariate analysis suggested that only laparoscopic surgery (versus open) and preoperative RT were risk factors for delay.
CONCLUSIONS: Rectal cancer resections are associated with a high incidence of sSSIs, over half of which are noted after discharge. Nine patient and operative characteristics, including smoking, BMI, COPD, APR, and open surgery were found to be significant risk factors for SSI on multivariate analysis. Furthermore, sSSI presentation in patients who had laparoscopic surgery and those who had preoperative RT is significantly delayed for unclear reasons.

PMID: 27979478 [PubMed - indexed for MEDLINE]




Low-Tube Voltage Computed Tomography During Hepatic Arterial Phase: The Effect of Body Habitus on Image Quality.
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Low-Tube Voltage Computed Tomography During Hepatic Arterial Phase: The Effect of Body Habitus on Image Quality.

J Comput Assist Tomogr. 2017 May/Jun;41(3):401-406

Authors: Park YS, Lee CH, Lee J, Choi JW, Kim KA, Park CM

Abstract
PURPOSE: This study aimed to evaluate the impact of body habitus factors on image quality of low-tube voltage computed tomography (CT) during the hepatic arterial phase.
MATERIALS AND METHODS: Ninety-seven patients (66 men, 31 women; age range, 26-78 years) who underwent clinically indicated liver dynamic CT examination were enrolled in the study. Analysis with 80-kVp CT and intermediate tube current (277-337 mA) was performed in the late hepatic arterial phase using a 320-detector row scanner with adaptive iterative dose reduction 3-dimensional reconstruction. Patient body habitus was measured using body weight (BW), body mass index (BMI), lateral width (LW) of the abdomen, and muscle volume (MV) of the abdominal wall. On hepatic arterial phase, the mean image noise and contrast-to-noise ratio (CNR) for the aorta and liver were assessed. The correlations between body habitus factors and image quality parameters were evaluated.
RESULTS: In all patients, MV showed the strongest correlation with image noise, followed by BW and LW (r = 0.684, 0.570, and 0.555, respectively). The BMI showed the fourth strongest correlation with image noise among all body habitus factors (r = 0.377). With respect to CNR of the aorta, MV and BW showed the strongest inverse correlation (r = -0.590 and -0.600, respectively), followed by LW and BMI (r = -0.557 and -0.423, respectively). Regarding the CNR of the liver, MV showed the strongest inverse correlation (r = -0.279), although the correlation efficiency was weak compared with other correlations.
CONCLUSIONS: Among various body habitus factors, MV showed the strongest association with image noise and CNR in the hepatic arterial phase using 80-kVp CT.

PMID: 27879528 [PubMed - indexed for MEDLINE]




Can we consider immediate complications after thyroidectomy as a quality metric of operation?
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Can we consider immediate complications after thyroidectomy as a quality metric of operation?

Surgery. 2017 Jan;161(1):156-165

Authors: Lifante JC, Payet C, Ménégaux F, Sebag F, Kraimps JL, Peix JL, Pattou F, Colin C, Duclos A, CATHY Study Group

Abstract
BACKGROUND: Permanent recurrent laryngeal nerve palsy and hypoparathyroidism are 2 major complications after thyroid operation. Assuming that the rate of immediate complications can predict the permanent complication rate, some authors consider these complications as a valid metric for assessing the performance of individual surgeons. This study aimed to determine the correlation between rates of immediate and permanent complications after thyroidectomy at the surgeon level.
METHODS: We conducted a prospective, cross-sectional study in 5 academic hospitals between April 2008 and December 2009. The correlation between the rates of immediate and permanent complications for each of the 22 participating surgeons was calculated using the Pearson correlation test (r).
RESULTS: The study period included 3,605 patients. There was a fairly good correlation between rates of immediate and permanent recurrent laryngeal nerve palsy (r = 0.70, P = .004), but no correlation was found for immediate and permanent hypoparathyroidism (r = 0.18, P = .427).
CONCLUSION: The immediate hypoparathyroidism rate does not reflect the permanent hypoparathyroidism rate. Consequently, immediate hypoparathyroidism should not be used to assess the quality of thyroidectomy or to monitor the performance of surgeons.

PMID: 27866716 [PubMed - indexed for MEDLINE]




Parathyroidectomy for primary hyperparathyroidism improves sleep quality: A prospective study.
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Parathyroidectomy for primary hyperparathyroidism improves sleep quality: A prospective study.

Surgery. 2017 Jan;161(1):25-34

Authors: La J, Wang TS, Hammad AY, Burgardt L, Doffek K, Carr AA, Shaker JL, Carroll TB, Evans DB, Yen TW

Abstract
BACKGROUND: This prospective survey study assessed changes in sleep quality in patients with primary hyperparathyroidism after parathyroidectomy.
METHODS: Patients undergoing parathyroidectomy for primary hyperparathyroidism (n = 110) or thyroidectomy for benign euthyroid disease (control group; n = 45) were recruited between June 2013 and June 2015 and completed the Pittsburgh Sleep Quality Index preoperatively and at 1- and 6 months postoperatively. "Poor" sleep quality was defined as a score >5; a clinically important and relevant improvement was a ≥3-point decrease.
RESULTS: Preoperatively, parathyroid patients had worse sleep quality than thyroid patients (mean 8.1 vs 5.3; P < .001); 76 (69%) parathyroid and 23 (51%) thyroid patients reported poor sleep quality (P = .03). Postoperatively, only parathyroid patients demonstrated improvement in sleep quality; mean scores did not differ between the parathyroid and thyroid groups at 1 month (6.3 vs 5.3; P = .12) or 6 months (5.8 vs 4.6; P = .11). The proportion of patients with a clinically important improvement in sleep quality was greater in the parathyroid group at 1 month (37% vs 10%; P < .001) and 6 months (40% vs 17%; P = .01). Importantly, there was no difference in the proportion of patients with poor sleep quality between the 2 groups at 1 month (50% vs 40%; P = .32) and 6 months (40% vs 29%; P = .22).
CONCLUSION: More than two-thirds of patients with primary hyperparathyroidism report poor sleep quality. After parathyroidectomy, over one-third experienced improvement, typically within the first month postoperatively.

PMID: 27865592 [PubMed - indexed for MEDLINE]




Scout-Based Automated Tube Potential Selection Technique (kV Assist) in Enhanced Chest Computed Tomography: Effects on Radiation Exposure and Image Quality.
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Scout-Based Automated Tube Potential Selection Technique (kV Assist) in Enhanced Chest Computed Tomography: Effects on Radiation Exposure and Image Quality.

J Comput Assist Tomogr. 2017 May/Jun;41(3):442-445

Authors: Li M, Feng S, Wu N, Zhang L

Abstract
OBJECTIVE: The aim of our study was to assess radiation dose reduction and image quality for enhanced chest CT examinations with a scout-based automated tube potential selection technique (kV Assist) compared with a standard 120-kV protocol.
METHODS: Prospective study of enhanced chest CT examinations was performed in 100 consecutive patients with kV Assist and in 100 consecutive patients with conventional 120-kV protocol on a multislice CT (Discovery CT750 HD). The body mass index, CT dose index volume, and dose length product were recorded from the examination protocol. Image noise and CT value was measured on region of interest, signal-to-noise ratio, and contrast-to-noise ratio was calculated. The subjective image quality was assessed by two radiologists blinded to the respective protocol with the use of a 3-grade scale (3, superior quality; 2, moderate quality; 1, inferior quality).
RESULTS: With kV Assist, the percentages of patients being scanned using 80, 100, and 120 kV were 12.0%, 80.0%, and 8.0%, respectively. The kilovolt setting was related with body mass index (r = 0.565, P = 0.000). Compared with the conventional 120 kV protocol, kV Assist allowed for an overall average decrease of 30.6% in CT dose index volume (kV Assist, 11.05 ± 4.78 mGy; 120 kV, 15.92 ± 6.89 mGy) (P < 0.001) and 32.3% in dose length product (kV Assist, 386.41 ± 184.02 mGy cm; 120 kV, 571.14 ± 286.68 mGy cm) (P < 0.001). In the kV Assist, mean attenuation of regions of interest inside the aorta was significantly higher than that in 120-kV protocols (kV Assist, 310.27 ± 73.70 HU; 120 kV, 239.44 ± 47.65 HU) (P < 0.001), resulting in increased contrast-to-noise ratio (kV Assist, 26.69 ± 7.78; 120 kV, 21.38 ± 6.05) (P < 0.001). There was no significant difference in subjective image quality scores between the 2 groups.
CONCLUSIONS: The use of attenuation-based kV Assist technique enables significant dose reduction in enhanced chest CT scan while improving arterial enhancement and preserving image quality at adequate levels.

PMID: 27759600 [PubMed - indexed for MEDLINE]




Development and psychometric evaluation of the Decisional Engagement Scale (DES-10): A patient-reported psychosocial survey for quality cancer care.
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Development and psychometric evaluation of the Decisional Engagement Scale (DES-10): A patient-reported psychosocial survey for quality cancer care.

Psychol Assess. 2016 Sep;28(9):1087-100

Authors: Hoerger M, Chapman BP, Mohile SG, Duberstein PR

Abstract
In light of recent health care reforms, we have provided an illustrative example of new opportunities available for psychologists to develop patient-reported measures related to health care quality. Patient engagement in health care decision making has been increasingly acknowledged as a vital component of quality cancer care. We developed the 10-item Decisional Engagement Scale (DES-10), a patient-reported measure of engagement in decision making in cancer care that assesses patients' awareness of their diagnosis, sense of empowerment and involvement, and level of information seeking and planning. The National Institutes of Health's ResearchMatch recruitment tool was used to facilitate Internet-mediated data collection from 376 patients with cancer. DES-10 scores demonstrated good internal consistency reliability (α = .80), and the hypothesized unidimensional factor structure fit the data well. The reliability and factor structure were supported across subgroups based on demographic, socioeconomic, and health characteristics. Higher DES-10 scores were associated with better health-related quality of life (r = .31). In concurrent validity analyses controlling for age, socioeconomic status, and health-related quality of life, higher DES-10 scores were associated with higher scores on quality-of-care indices, including greater awareness of one's treatments, greater preferences for shared decision making, and clearer preferences about end-of-life care. A mini-measure, the DES-3, also performed well psychometrically. In conclusion, DES-10 and DES-3 scores showed evidence of reliability and validity, and these brief patient-reported measures can be used by researchers, clinicians, nonprofits, hospitals, insurers, and policymakers interested in evaluating and improving the quality of cancer care. (PsycINFO Database Record

PMID: 27537003 [PubMed - indexed for MEDLINE]




Evaluation of image quality in carotid and cerebrovascular disease: a comparative study between subtraction and routine computed tomography angiography.
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Evaluation of image quality in carotid and cerebrovascular disease: a comparative study between subtraction and routine computed tomography angiography.

Echocardiography. 2016 Nov;33(11):1735-1740

Authors: Zhao DL, Wan Y, Wang GK, Wang HB, Liang HW, Zhou HT, Gao L, Zhang JL

Abstract
OBJECTIVE: Few data exist comparing the image quality and diagnostic accuracy of subtraction computed tomography (CT) angiography (SCTA) in carotid and cerebrovascular arteries with routine CT angiography (RCTA).
PATIENTS AND METHODS: In this study, 56 patients underwent 128-row CT angiography of these vessels with review by two radiologists using routine, nonsubtracted, and SCTA protocols. Comparisons were made using a 4-point subjective rating scale in all patients. Eighteen patients were examined with both SCTA and invasive digital subtraction angiography (DSA). The accuracy of SCTA and routine CTA reformations was assessed and compared by both patient-based and vessel-based analyses of intracranial aneurysms and intracranial and extracranial arterial stenotic lesions using DSA results as the reference standard.
RESULTS: Diagnostic accuracy in the adjacent skull base portion of the internal carotid artery (ICA) and reading time for cerebral aneurysms and vessel stenoses were obviously improved with SCTA protocol, but the accuracy in vertebro-basilar arteries was no different. The diagnostic accuracy in general was slightly increased compared with routine CTA.
CONCLUSION: Review of SCTA images is an effective means to remove bone close to vessels as seen on routine CTA and has good image quality and diagnostic accuracy. SCTA is superior to routine CTA in the visualization and diagnostic accuracy of adjacent skull base part of the ICA and decreases reading time for carotid and cerebrovascular arterial imaging.

PMID: 27528234 [PubMed - indexed for MEDLINE]




Effect of Functional Status on the Quality of Bowel Preparation in Elderly Patients Undergoing Screening and Surveillance Colonoscopy.
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Effect of Functional Status on the Quality of Bowel Preparation in Elderly Patients Undergoing Screening and Surveillance Colonoscopy.

Gut Liver. 2016 Jul 15;10(4):569-73

Authors: Kumar A, Lin L, Bernheim O, Bagiella E, Jandorf L, Itzkowitz SH, Shah BJ

Abstract
BACKGROUND/AIMS: Optimal bowel preparation is essential for successful screening or for surveillance colonoscopy (SC). Inadequate bowel preparation is associated with older age, the male gender, and the presence of certain comorbidities. However, the association between patients' functional status and bowel preparation quality has not been studied. We prospectively examined the relationship between functional status, namely, the ability to perform activities of daily living (ADLs) and ambulate, and the quality of bowel preparation in elderly patients undergoing SC.
METHODS: Before undergoing SC, 88 elderly patients were surveyed regarding their functional status, specifically regarding their ability to perform ADLs and ambulate a quarter of a mile. Gastroenterologists then determined the quality of the bowel preparation, which was classified as either adequate or inadequate. Then, the frequency of inadequate bowel preparation in patients who did or did not experience difficulty performing ADLs and ambulating was calculated.
RESULTS: Difficulty ambulating (unadjusted odds ratio [OR], 4.83; p<0.001), difficulty performing ADLs (OR, 2.93; p=0.001), and history of diabetes (OR, 2.88; p=0.007) were significant univariate predictors of inadequate bowel preparation. After adjusting for the above variables, only difficulty ambulating (adjusted OR, 5.78; p=0.004) was an independent predictor of inadequate bowel preparation.
CONCLUSIONS: Difficulty with ambulation is a strong predictor of inadequate bowel preparation in elderly patients undergoing SC.

PMID: 27021501 [PubMed - indexed for MEDLINE]