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To measure efficiency in Intensive Care Units (ICUs) and to determine which organizational factors are associated with ICU efficiency, taking confounding factors into account.
We used data of all consecutive admissions to Dutch ICUs between January 1, 2016 and January 1, 2019 and recorded ICU organizational factors. PF-06700841 in vitro We calculated efficiency for each ICU by averaging the Standardized Mortality Ratio (SMR) and Standardized Resource Use (SRU) and examined the relationship between various organizational factors and ICU efficiency. We thereby compared the results of linear regression models before and after covariate adjustment using propensity scores.
We included 164,399 admissions from 83 ICUs. ICU efficiency ranged from 0.51-1.42 (average 0.99, 0.15 SD). The unadjusted model as well as the propensity score adjusted model showed a significant association between the ratio of employed intensivists per ICU bed and ICU efficiency. Other organizational factors had no statistically significant association with ICU efficiency after adjustment.
We found marked variability in efficiency in Dutch ICUs. After applying covariate adjustment using propensity scores, we identified one organizational factor, ratio intensivists per bed, having an association with ICU efficiency.
We found marked variability in efficiency in Dutch ICUs. After applying covariate adjustment using propensity scores, we identified one organizational factor, ratio intensivists per bed, having an association with ICU efficiency.
To investigate the impact of positron emission tomography/computed tomography (PET/CT) on clinical management in patients with esophageal cancer and its link to overall survival (OS) in a real-world setting.
A patient cohort with advanced esophageal cancer undergoing PET/CT was prospectively enrolled in a registry study between 04/2013 and 06/2019. Intended patient management prior and after PET/CT was documented based on standardized questionnaire data. Management changes after PET/CT were recorded including major changes concerning the treatment goal (curative vs. palliative) and minor changes (therapy adjustments). OS was analyzed for subgroups with squamous cell carcinomas (SCC) or adenocarcinomas (AC) and stratified for extent of metastatic disease and treatment goals.
257 patients (53 female;65.5 ± 10.0 yr.) were included. After PET/CT, major changes of intended therapy were observed in 34/257 patients (13.2%), from curative to palliative (8.2%), palliative to curative (1.9%) and from "not finallynostic procedures.
To compare the image quality of the reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) with the full field-of-view (fFOV) DWI in the assessment of bladder cancer (BC); and to explore the possible superiority of bi-planar (axial and sagittal) rFOV DWI over single planar fFOV DWI in predicting muscle-invasiveness of BC.
This retrospective study analyzed 61 patients with BC who underwent DWI sequences including axial fFOV DWI, axial rFOV DWI, and sagittal rFOV DWI. Qualitative and quantitative image quality assessment were compared between axial fFOV DWI and rFOV DWI sequences. The tumor with its base could be clearly displayed on DWI was defined as the evaluable lesion, and the number of evaluable lesions detected from single axial fFOV DWI, axial rFOV DWI, sagittal rFOV DWI, and bi-planar rFOV DWI sequences was recorded and compared. The apparent diffusion coefficient (ADC) was compared between non-muscular-invasive bladder cancer (NMIBC) and muscular-invasive bladder cancer (MIBC) based on the rve, 0.946) for predicting the presence of muscle-invasiveness of BC.
Bi-planar rFOV DWI may provide more diagnostic confidence than the single planar DWI for predicting the presence of muscle-invasiveness in BC, with improved image quality over the fFOV DWI.
Bi-planar rFOV DWI may provide more diagnostic confidence than the single planar DWI for predicting the presence of muscle-invasiveness in BC, with improved image quality over the fFOV DWI.
To prospectively compare the diagnostic efficacy of conventional diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in differentiating between muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC).
Multiple b value DWIs were performed using a 3-T magnetic resonance (MR) imaging unit in fifty-one patients with bladder cancer including MIBC and NMIBC confirmed by histopathological findings. DWI data were postprocessed using mono-exponential and DKI models to calculate the apparent diffusion coefficient (ADC), apparent diffusional kurtosis (K
), and kurtosis-corrected diffusion coefficient (D
). Receiver-operating characteristic (ROC) analysis was performed to compare the diagnostic efficacy of all diffusion parameters.
All parameters differed significantly between MIBC and NIMBC including increased K
, decreased D
and ADC (all p < 0.001). Only the combination of D
and K
was significantly higher than ADC (p < 0.05), whilst D
and K
were not statistically different from ADC.
Both conventional DWI and DKI models are beneficial in differentiating between MIBC and NMIBC, whilst the combination of D
and K
can produce a more robust value than conventional ADC value in evaluating aggressiveness of bladder cancer.
Both conventional DWI and DKI models are beneficial in differentiating between MIBC and NMIBC, whilst the combination of Dapp and Kapp can produce a more robust value than conventional ADC value in evaluating aggressiveness of bladder cancer.
Ultrasonography is the most common imaging modality used to diagnose carpal tunnel syndrome (CTS). Recently artificial intelligence algorithms have been used to diagnose musculoskeletal diseases accurately without human errors using medical images. In this work, a computer-aided diagnosis (CAD) system is developed using radiomics features extracted from median nerves (MN) to diagnose CTS accurately.
This study is performed on 228 wrists from 65 patients and 57 controls, with an equal number of control and CTS wrists. Nerve conduction study (NCS) is considered as the gold standard in this study. Two radiologists used two guides to evaluate and categorize the pattern and echogenicity of MNs. Radiomics features are extracted from B-mode ultrasound images (Ultrasomics), and the robust features are fed into support vector machine classifier for automated classification. The diagnostic performances of two radiologists and the CAD system are evaluated using ROC analysis.
The agreement of two radiologists was excellent for both guide 1 and 2. The honey-comb pattern clearly appeared in control wrists (based on guide 1). In addition, CTS wrists indicated significantly lower number of fascicles in MNs (based on guide 2). The area under ROC curve (AUC) of the radiologist 1 and 2 are 0.658 and 0.667 based on guide 1 and 0.736 and 0.721 based on guide 2, respectively. The CAD system indicated higher performance than two radiologists with AUC of 0.926.
The proposed CAD system shows the benefit of using ultrasomics features and can assist radiologists to diagnose CTS accurately.
The proposed CAD system shows the benefit of using ultrasomics features and can assist radiologists to diagnose CTS accurately.Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disorder characterized by alpha-L-iduronidase (IDUA) deficiency, an enzyme responsible for glycosaminoglycan degradation. Musculoskeletal impairment is an important component of the morbidity related to the disease, as it has a major impact on patients' quality of life. To understand how this disease affects bone structure, morphological, biomechanical and histological analyses of femurs from 3- and 6-month-old wild type (Idua +/+) and MPS I knockout mice (Idua -/-) were performed. Femurs from 3-month-old Idua -/- mice were found to be smaller and less resistant to fracture when compared to their age matched controls. In addition, at this age, the femurs presented important alterations in articular cartilage, trabecular bone architecture, and deposition of type I and III collagen. At 6 months of age, femurs from Idua -/- mice were more resistant to fracture than those from Idua +/+. Our results suggest that the abnormalities observed in bone matrix and articular cartilage in 3-month-old Idua -/- animals caused bone tissue to be less flexible and more likely to fracture, whereas in 6-month-old Idua -/- group the ability to withstand more load before fracturing than wild type animals is possibly due to changes in the bone matrix.
Challenging emergency caring situations can contribute to compassion fatigue and burnout among emergency nurses. These variables have been widely researched, although not among Chinese nurses. Pertinent findings will extend the international literature in this domain.
This study aimed to develop and test a model that delineates the predictive relationship that empathy, self-compassion, job satisfaction, individual and work-related factors share with compassion fatigue, burnout, and compassion satisfaction.
A cross-sectional survey design was adopted. Data were collected from 186 emergency nurses recruited from eight hospitals across six cities in China. Descriptive statistics were computed, and univariate and hierarchical multiple regression analyses were conducted.
Empathy, job satisfaction, and self-compassion explained a substantial proportion of the variance in compassion fatigue, burnout, and compassion satisfaction. Factors related to life disruption and traumatic memories significantly predicted compassion fatigue and burnout. The final model included the following predictors prior history of a severe illness, perspective taking, compassionate care, employee engagement, mindfulness, self-judgement, and over-identification.
Stress involved in providing emergency care may increase emotional and work-related burden among emergency nurses. Organisations should design interventions that nurture empathy, promote self-compassion, and improve job satisfaction to alleviate their compassion fatigue and burnout and increase compassion satisfaction.
Stress involved in providing emergency care may increase emotional and work-related burden among emergency nurses. Organisations should design interventions that nurture empathy, promote self-compassion, and improve job satisfaction to alleviate their compassion fatigue and burnout and increase compassion satisfaction.Many researches have been undergone to hasten the natural wound healing process. In this study, several Hibiscus species (leaves) were extracted with petroleum ether, methanol, and their mucilage was separated. All the tested species extracts were assessed for their viability percentage using the water-soluble tetrazolium. H.syriacus was the plant of choice to be incorporated in a new drug delivery system and evaluated for its wound healing activity. H.syriacus petroleum ether extract (PEE) showed a high percentage of palmitic and oleic acids while its mucilage demonstrated high glucosamine and galacturonic acid. It was selected to be formulated and pharmaceutically evaluated into three different composite sponges using chitosan in various ratios. Fourier-transformed infrared spectroscopy investigated the chemical interaction between the utilized sponges' ingredients. Morphological characteristics were evaluated using scanning electron microscopy. H.syriacus composite sponge of mucilage chitosan (15) was loaded with three different concentrations of PEE.
