This is the first nationwide study focusing exclusively on blind boarding schools in Ethiopia. The study examined the experiences and perceptions of Ethiopian blind boarding school teachers regarding pre-braille skills, unified English braille, and braille (mathematics, technology, usage, and inclusivity). Seven blind boarding schools and their 110 teachers (98.21%) were involved using the census sampling technique. Researchers collected data through questionnaires and analysed it using Bayesian and ordinal logistic regression. Teachers were more likely to favour situations with insufficient teaching materials and limited exposure to pre-braille implementation (95% credible interval of OR: [1.138, 1.592]; OR = 1.345). Teachers without visual impairment perceived braille maths content as difficult and lacked access to learn and access mathematics in braille (95% credible interval of OR is [1.075, 2.102]; OR = 1.503). Agreement on the need for special classes in inclusive settings was significantly higher for students with visual impairment (OR = 4.61, p = 0.001). Voice recorders (OR = 4.85, p = 0.003) and text-to-speech software (OR = 3.61, p = 0.001) significantly hindered braille development and adoption. Participants showed slight motivational agreement on technology in braille instruction (OR = 1.09, p = 0.003) and strong agreement regarding improved learning outcomes (OR = 469.21, p = 0.001). Further research should investigate UEB awareness and the impact of braille technologies on students with visual impairments' academic performances. Teachers and curriculum developers should emphasise pre-braille skills, braille maths, braille tech, and transcription services. The study “Teachers’ Experiences and Perceptions of Pre-Braille Skills, Unified English Braille, and Braille (Maths, Techs, Usage, Inclusivity) in Ethiopian Boarding Schools for the Blind” examines the role of rehabilitation in this educational context. It considers how rehabilitation services and philosophies shape teachers’ approaches to pre-braille skill development, the use of Unified English Braille, and the integration of braille in subjects such as mathematics and technology. The research also analyzes how rehabilitation strategies affect the inclusivity of blind students in Ethiopian boarding schools for the blind. By exploring educators’ perceptions of rehabilitation, the study assesses how these views influence teaching methods and expectations for student learning and adaptation. Ultimately, the research evaluates whether rehabilitation supports or challenges the educational framework for students with visual impairment in Ethiopia, as seen through teachers’ perspectives and practices.
Mild traumatic brain injury (mTBI) is a prevalent neurological condition, affecting millions worldwide, and frequently resulting in persistent cognitive impairment that significantly impacts daily functioning. Current clinical management and recommendations lack evidence based therapeutic interventions, with treatment approaches limited to symptom monitoring and activity modification. Non-pharmaceutical interventions are needed to promote cognitive recovery and mitigate long-term consequences of mTBI. The goal of this randomized control pilot study is to evaluate the feasibility and preliminary efficacy of a symptom-guided and virtually delivered aerobic exercise intervention for improving cognitive function following mTBI. We are conducting a 12-week pilot randomized control trial of exercise to promote recovery from mTBI, which aims to recruit 24 participants who have suffered an mTBI within the last year and are between the ages of 18-55 years old. Participants are randomly assigned to one of two groups: an intervention group receiving 90 min of virtually-delivered, symptom-guided aerobic exercise weekly for 12 weeks, or a control group receiving 90 min of virtually-delivered balance exercises weekly for 12 weeks. Comprehensive assessments, including cognitive testing and multimodal neuroimaging, were conducted pre and post intervention. We implement physical activity monitoring during weeks 1, 6, and 12 using accelerometry to measure behavior changes. This study will establish the feasibility of virtual exercise delivery in mTBI populations and preliminary evidence regarding cognitive and brain health benefits of aerobic exercise in mTBI. Results will inform future large-scale trials and contribute to an accessible, evidence-based intervention for cognitive recovery after mTBI.
Pharmacy technician responsibilities, certifications, and duties across pharmacy settings have evolved in recent years, allowing them to potentially become a valuable resource for skills-based pharmacy education. Our institution has employed pharmacy technicians since 2014. This brief commentary addresses the training and roles of pharmacy technician staff in our skills-based education curriculum.
Obtaining accurate medication histories for older adults in the emergency department (ED) is essential but challenging due to operational barriers and incomplete electronic health records (EHRs). We implemented a stakeholder-engaged intervention integrating pharmacy technicians (pharm techs) to obtain triage medication histories (T-MHs) for ED patients aged 65 years or older. Starting in June 2023, pharm techs collected T-MHs from patients awaiting clinician evaluation. The intervention was developed using literature review, EHR data analysis, and focus groups with ED clinicians, pharm techs, and pharmacists. We identified key chief complaint-medication interactions and designed ED workflows for T-MH implementation. Three high-impact chief complaint-medication interactions were identified: (1) trauma with anticoagulant use; (2) any complaint with recent medication changes or adherence concerns; and (3) any complaint while on antibiotics. We educated pharm techs about these chief complaint-medication interactions and asked them to notify ED clinicians about cases identified. T-MHs were obtained in 3,197 ED encounters (41.2%) before any medication order or disposition decision. Focus groups revealed that patients and their care partners generally agreed to participate in medication histories, but, contrary to expectations, efforts to date have had minimal impact on clinician awareness of prior-to-admission medications, prescribing decisions, and disposition decisions. Integrating pharm techs to obtain medication histories in the ED is feasible and acceptable, but further efforts are needed to optimize workflow integration and handoff processes to improve clinical impact and patient safety.
A new design concept, tether-entangled conjugated helices (TECHs), is introduced for helical polyaromatic molecules. TECHs consist of a linear polyaromatic ladder backbone and periodically entangling tethers with the same planar chirality. By limiting the length of tether, all tethers synchronously bend and twist the backbone with the same manner, and change it into a helical ribbon with a determinate helical chirality. The 3D helical features are customizable via modular synthesis by using two types of synthons, the planar chiral tethering unit (C 2 symmetry) and the docking unit (C 2h symmetry), and no post chiral resolution is needed. Moreover, TECHs possess persistent chiral properties due to the covalent locking of helical configuration by tethers. Concave-type and convex-type oligomeric TECHs are prepared as a proof-of-concept. Unconventional double-helix π-dimers are observed in the single crystals of concave-type TECHs. Theoretical studies indicate the smaller binding energies in double-helix π-dimers than conventional planar π-dimers. A concentration-depend emission is found for concave-type TECHs, probably due to the formation of double-helix π-dimers in the excited state. All TECHs show strong circularly polarized luminescence (CPL) with dissymmetric factors (|g lum|) generally over 10-3. Among them, the (P)-T4-tBu shows the highest |g lum| of 1.0 × 10-2 and a high CPL brightness of 316 M-1 cm-1.
Progressing from Emergency Department technician (ED tech) to Emergency Department registered nurse (ED RN) represents a significant professional transition in emergency care. This study explored the lived experiences of ED RNs who previously worked as ED techs to better understand how prior ED tech roles influenced professional development and career trajectory within emergency nursing practice. A hermeneutic phenomenological approach grounded in Heidegger's philosophy guided this study. Semi-structured interviews were conducted with ED RNs (n = 11) practicing in emergency departments within Level I trauma centers. Data were analyzed using iterative thematic analysis informed by the Hermeneutic Circle. Benner's Novice to Expert Theory supported interpretation. Three major themes emerged: (1) preparedness for RN transition, (2) professional identity and fulfillment, and (3) relational practice in emergency care. Together, these findings illustrate how early ED tech experience fosters professional development and may influence future career advancement within emergency nursing practice. ED tech experience may enhance preparedness, resilience, and interpersonal skills during the ED RN transition. Onboarding and mentorship tailored specifically for ED techs transitioning to the RN role can build on these strengths while addressing identity shift and delegation challenges that may otherwise complicate early role adaptation.
To evaluate the effectiveness of the Mental Training Tech 24.5 (MTT24.5) cognitive stimulation program, designed to enhance cognitive performance and neuroplasticity in healthy adults. Cognitive decline is a significant concern in aging populations, with research suggesting that neuroplasticity and cognitive reserve can be enhanced through targeted cognitive training. The MTT24.5 program aims to stimulate brain function through a combination of new knowledge acquisition (DATA) and learning techniques (TECHS), organized into a systematic algorithm. This approach may offer a novel way to prevent or mitigate age-related cognitive decline. Pilot clinical study, active-controlled, open randomization. Adults from the general population with no clinical cognitive deterioration, recruited from three sites within the Autonomous City of Buenos Aires and its metropolitan area. 120 volunteers were enrolled, of which 76 participants (56 in the intervention group, 20 in the control group) met the study requirements and selected a site closest to their residence. The MTT24.5 program consists of 12 weekly in-person sessions (totaling 24.5 hours), during which participants learned 40 knowledge units (DATA) and 100 learning techniques (TECHS). These were organized into binomials, where each unit of DATA was paired with 3-4 TECHS. Pre- and post-intervention assessments included medical history, lifestyle factors, cognitive reserve scale, Addenbrooke's Cognitive Examination-Revised (ACE-R), and Mini-Mental State Examination (MMSE). The mean age was 59 years for both groups. Baseline ACE-R scores were comparable (91.3). The global cognitive score increased by 4.6 points (5%) in the intervention group compared to a decrease of 0.5 points in the control group (p < 0.001). The most significant improvement was observed in the memory domain (2.4 points, 11.4% increase) versus a 0.3-point increase in the control group (p < 0.007), with secondary improvements in verbal fluency, language, and visuospatial skills. Notably, participants with baseline ACE-R scores below 85 showed greater improvements (p < 0.003). The effects were consistent across various phenotypic factors, such as age, sex, chronic disease distribution, and lifestyle. The MTT24.5 program, based on a systematic algorithm for acquiring new knowledge and skills, significantly enhances cognitive reserve and overall cognitive performance, particularly in individuals with lower baseline cognitive scores. These findings suggest that structured cognitive stimulation could play a critical role in preventing cognitive decline and promoting cognitive health in healthy adults. Given the promising results, future studies involving larger populations and long-term follow-up are essential to validate these effects and explore the potential for mitigating age-related cognitive decline and enhancing quality of life. The study was registered in accordance with local regulations at the National Council for Scientific and Technological Research (CONICET) - Institute of Biomedical Research (BIOMED), and also in the National Ethics Committee, and at clinicaltrials.gov (NCT06549517).
Online delivery of HIV pre- and post-exposure prophylaxis (PrEP and PEP) could address persistent access barriers, yet implementation across Africa remains limited. The ePrEP Kenya Pilot (NCT05377138) integrated PrEP and PEP services into an existing e-pharmacy platform and identified client- and provider-level barriers and facilitators to use. In the pilot, clinicians screened adults (age 18+) in Nairobi and Mombasa Counties for PrEP and PEP eligibility via telehealth; pharmaceutical technologists courier-delivered HIV testing services (including self-testing) and dispensed PrEP or PEP to eligible clients who paid 150-250 KES (∼$1-2 USD) for HIV testing, ≤149 KES (∼$1 USD) for courier delivery and nothing for telehealth consultation or PrEP/PEP drugs. We conducted monthly check-in calls with providers and, near study endline, in-depth interviews (IDIs) with purposively sampled clients and all providers. We analysed verbatim call transcripts and IDIs inductively, then mapped identified barriers and facilitators to the Consolidated Framework for Implementation Research (CFIR). From February to November 2023, we conducted 10 check-in calls and interviewed 30 clients (10 PEP, 10 PrEP with 1+ refill, 10 PrEP with no refills) and 10 providers (4 clinicians, 6 pharm techs). Clients had a median age of 27 years (IQR 25-30) and providers 28 years (IQR 27-31); 53% (16/30) of clients and 30% (3/10) of providers were female. In the Outer Setting CFIR domain, providers identified motorcycle manoeuvrability as a delivery facilitator but noted that traffic, poor road infrastructure, bad weather and personal safety concerns posed challenges. In the Inner Setting domain, providers identified information-sharing practices and collegiality as facilitators. In the Individuals domain, clients' capability, opportunity and motivation to use online PrEP/PEP services was reportedly facilitated by app-guided HIV self-testing, broad delivery zones and enhanced privacy, but hindered by low awareness of these services, limited access to internet-enabled devices, data security concerns and uncertainties around couriers' pharmacy credentials. Recommendations included reducing client costs, expanding delivery coverage and hours, and offering alternative delivery options (e.g. medication pick-up lockers). Online PrEP and PEP delivery is a promising differentiated service model, especially if partially subsidized by third-party payers. Implementation success will require model adaptations that address logistical, infrastructural and awareness barriers.
Limited research exists on the experiences of hijab-wearing Muslim medical students. This study explored the barriers faced by these students while participating in surgery. This was a descriptive study using a primarily qualitative approach. Survey data were collected to provide context and to recruit participants for in-depth semi-structured interviews, which were analyzed using reflexive thematic analysis. The study focused on peri‑operative and surgical training environments in medical institutions where Muslim medical trainees were completing clinical rotations or surgical electives. Twenty-two Muslim women in medical training completed the survey. Six of the survey respondents participated in semi-structured interviews to provide deeper insights into their experiences. Survey responses revealed feelings of anxiety, embarrassment, and heightened scrutiny in peri‑operative spaces related to wearing the hijab. In interviews, many described a lack of inclusive training and additional mental burdens compared to non-hijab-wearing peers. Many participants expressed avoiding the operating room altogether due to concerns about their hijab, citing fears of being perceived as unprofessional or experiencing bias from surgical teams. These findings highlight systemic barriers, including discrimination and exclusion, which came from attending surgeons, nurses, scrub techs, patients, and more, that deter hijab-wearing Muslim trainees from considering surgical specialties. Implementing inclusive policies and cultural sensitivity training for surgical staff can improve diversity and create a supportive environment for all trainees.
Cardiovascular magnetic resonance (CMR) could be considered as first diagnostic test in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS), since up to one-third do not have obstructive coronary artery disease (CAD). This meta-analysis aimed to investigate (i) the diagnostic accuracy of CMR to detect obstructive CAD and NSTE-ACS, and (ii) the prognostic value of CMR in patients with suspected NSTE-ACS. Pubmed, Embase, and Cochrane Library were searched (30 November 2024) for eligible studies. To determine the diagnostic accuracy of CMR prior to invasive coronary angiography, sensitivity, specificity, and likelihood ratios (LR+/-) were calculated for each endpoint. Data were pooled using a bivariate random-effects model. This meta-analysis was pre-registered in PROSPERO (CRD42024625306). Sixteen studies with 1386 patients were included. The pooled sensitivity and specificity to detect obstructive CAD (eight studies) were 85% (95%CI 78-91%) and 73% (95%CI 57-85%). The pooled LR+ and LR- were 3.20 (95%CI 1.78-5.73) and 0.20 (95%CI 0.11-0.36). The pooled sensitivity and specificity to diagnose NSTE-ACS (five studies) were 83% (95%CI 73-89%) and 89% (95%CI 72-96%). The pooled LR+ and LR- were 7.45 (95%CI 2.77-20.02) and 0.20 (95%CI 0.13-0.30). Finally, the pooled sensitivity and specificity for prognosis based on ACS-related outcomes (four studies) were 98% (95%CI 42-100%) and 85% (95%CI 65-95). The pooled LR+ and LR- were 6.55 (95%CI 2.45-17.54) and 0.03 (95%CI 0-1.54). CMR can detect obstructive CAD and diagnose NSTE-ACS with excellent pooled sensitivity and specificity. CMR findings are strongly associated with clinical outcome in patients with suspected NSTE-ACS.
To develop a simple rule-of-thumb on how to reduce the contrast medium (CM) dose in photon-counting detector CT (PCD-CT) when lowering the energy of the reconstructed virtual mono-energetic images (VMI) while maintaining the contrast-to-noise ratio (CNR) for parenchymal CT and CTA. Spectral abdominal and chest CT phantoms were scanned using a portal venous phase (PVP) abdominal and a high-pitch CTA protocol, respectively, on a first-generation dual-source PCD-CT. The phantoms contained cylindrical rods with iodine in water equivalent material (0.5/1.0/2.0/5.0/10.0/15.0 mg I/mL) and ICRU muscle tissue. The phantoms were complemented with 2 fat equivalent rings to mimic different patient sizes. Iodine contrast, image noise, noise power spectra (NPS), and iodine CNR were investigated in VMIs with different energies (40 to 60 keV in steps of 5 keV). This was done for different iodine concentrations, phantom sizes, x-ray tube voltages (120 kV and 140 kV) and radiation doses. In addition, 15 abdominal and 15 CT angiographic patient scans [body mass index (BMI) range: 17 to 37 kg/m 2 ] were retrospectively analyzed to determine the CNR at different VMI energies. Contrast at a given iodine concentration and VMI energy was independent of phantom size, radiation dose, and acquisition voltage (kV). With decreasing VMI energy, the maximum of the NPS curves increased, while their shape remained similar, indicating higher noise but similar noise texture. The CNR increased with lower VMI energy for a given iodine concentration and phantom size, while CNR decreased with increasing phantom size for a given VMI energy and iodine concentration. When the VMI energy was lowered by 5 keV steps in the range of 60 to 40 keV, similar CNR could be maintained when reducing the iodine concentration at each step by 11.7% to 13.7% for abdominal PVP scans and 11.8% to 14.5% for CTAs. CNR analysis of the patient scans confirmed these findings: a 5 keV reduction in VMI energy led to a mean±SD 11.4%±0.4% and 13.7%±1.0% increase in CNR for abdomen PVP and CTA scans, respectively. This can be translated to a corresponding reduction in CM dose when a constant CNR is aimed for. From these results, a simple, robust rule-of-thumb was derived, the 10-to-5 rule: For the evaluated PCD-CT protocols, CNR can be maintained with about 10% less CM dose for each reduction of the VMI energy by 5 keV. This phantom study, which was complemented with a retrospective proof-of-principle patient study, showed that a simple, easy to implement 10-to-5 rule-of-thumb might be used in daily practice for contrast-enhanced PCD-CT. It allows for individual adaptation of the CM dose to the VMI energy applied.
CT image quality is strongly influenced by the energy of the x-ray beam. The tube voltage (kV) determines a polyenergetic x-ray spectrum, which affects both image contrast and noise in conventional energy-integrating detector CT (EID-CT) imaging. In photon-counting detector CT (PCD-CT), spectral data sets are always available by default, and virtual monoenergetic images (VMI) can be reconstructed at any specific photon energy (keV). This enables radiologists to tailor energy selection to dedicated clinical tasks, achieving an optimal balance between contrast, noise, and radiation dose, and ultimately enhancing diagnostic confidence. This article educates the reader on the differences between polyenergetic and monoenergetic images to provide radiologists with practical insights into optimizing spectral imaging protocols and leveraging keV differences in routine clinical practice. Using an anthropomorphic phantom with iodine rods, differences in image quality, specifically image contrast and noise, are demonstrated between polyenergetic EID-CT and PCD-CT VMIs.
To demonstrate the feasibility of performing in-vivo imaging and quantitative relaxation mapping of soft and hard tissues using a low-cost, portable MRI scanner, and to establish the methodological foundations for zero echo time (ZTE) imaging in systems subject to strong field inhomogeneities. A complete framework for artifact-mitigated ZTE imaging at low field was developed, including: (i) RF pulse pre/counter-emphasis calibration to minimize ring-down and electronics switching time; (ii) an extension of a recent single-point double-shot (SPDS) protocol for simultaneous [Formula: see text] and [Formula: see text] mapping; and (iii) a model-based reconstruction incorporating these field maps into the encoding matrix. ZTE imaging and variable flip angle (VFA) [Formula: see text] mapping were performed on phantoms and in-vivo human knees and ankles, and benchmarked against standard RARE and STIR acquisitions. The optimized PETRA sequence produced 3D images of knees and ankles in [Formula: see text] min, revealing hard tissues such as ligaments, tendons, cartilage, and bone, usually not visible with standard sequences. The extended SPDS method was used for [Formula: see text] mapping, while the VFA approach provided the first in-vivo [Formula: see text] measurements of hard tissues at [Formula: see text] T. The proposed framework broadens the range of pulse sequences feasible in portable low-field MRI and demonstrates the potential of ZTE for quantitative and structural imaging of musculoskeletal tissues in affordable Halbach-based systems.
The randomised controlled clinical RACER trial studied the diagnostic work-up with contrast-enhanced mammography (CEM) compared to conventional imaging as the primary tool in women recalled from breast cancer screening. This current trial-based economic evaluation was performed from a hospital perspective. Cost prices were retrieved from the financial departments of the Maastricht University Medical Centre. Health-related quality of life was measured five times over 18 months using the EQ-5D-5L questionnaire. Cost-utility analysis outcome was expressed as costs per quality-adjusted life year (QALY). Multiple imputation was used for missing data, and non-parametric bootstrap analysis was performed to examine uncertainty in the difference in costs and incremental costs per QALY. Post hoc subgroup analysis was performed per BI-RADS recall score. Work-up with CEM showed lower total costs of €-117 (95% CI €-254; €+22) compared to conventional imaging. Average imaging costs were significantly lower with CEM (mean difference €-130; 95% CI €-153; €-105). Mean QALY for the CEM group was 1.2034 versus 1.2137 for the control group. Bootstrap analysis showed that 95% of all simulated ICERs were in the quadrants that indicate cost-savings, although 25% of the ICERs showed a small gain in QALY and 70% a small QALY loss. The probability of CEM being cost-effective is 53% at a threshold of €10,000 to accept a QALY loss. In the subgroup of BI-RADS 0 recalls, specifically, this probability is 85%. CEM as a primary tool in the diagnostic work-up is a cost-effective diagnostic strategy, especially in BI-RADS 0 recalls. Question Diagnostic accuracy is similar with contrast-enhanced mammography (CEM) compared to conventional as primary imaging. However, while the work-up is more efficient, is it also a cost-effective strategy? Findings Using CEM as primary imaging tool in the diagnostic work-up of recalls from screening results in lower costs with similar QALY compared to conventional imaging. Clinical relevance In BI-RADS- 0 (low suspicion) recalls, CEM should be used as primary imaging modality instead of conventional imaging. CEM compared to conventional imaging in the work-up of recalled women is cost-effective. In other recalls, CEM should be strongly considered.
Portable low-field (<0.1T) MRI is increasingly used for point-of-care imaging, but electromagnetic interference (EMI) presents a significant challenge, especially in unshielded environments. EMI can degrade image quality and compromise diagnostic utility. This study investigates whether subject grounding can effectively reduce EMI and improve image quality, comparing different grounding strategies. Experiments were conducted using a 47 mT Halbach-based MRI scanner with a single receive channel. Reproducibility was evaluated at a second site using a 72 mT scanner with similar geometry. Turbo spin echo sequences were used to image the hand and brain. Subject grounding was implemented using conductive cloth sleeves or electrocardiography (ECG) electrodes, each connected between the subject's skin and scanner ground. Three EMI conditions were tested: ambient, added single-frequency EMI, and broadband EMI. SNRs were calculated under each configuration. Subject grounding significantly reduced EMI in both hand and brain scans. In hand imaging, conductive sleeves reduced noise from 85× to 1.25× the 50-ohm noise floor. In brain imaging, grounding alone reduced noise from 55× to 25× baseline; when combined with arc RF shields, noise was further reduced to 1.2× baseline, even under added EMI. These results were reproducible across different scanners and locations. Subject grounding is a simple, effective, and reproducible strategy for mitigating EMI in portable low-field MRI. It is especially effective for hand imaging, while brain imaging benefits from additional RF shielding. The approach is robust under various EMI conditions and may complement other denoising techniques.
Microsurgical breast reconstruction is intraoperatively complex. Evidence of standardized workflows improving outcomes exists, but the impact of staffing cases with familiar personnel is not documented.All microsurgical breast reconstructions (July 2021-June 2024) at our institution were analyzed for staff familiarity at granular time intervals (T0: setup to incision, T1-T3: each third of procedure). Staff were deemed "unfamiliar" if they staffed <2 microsurgical breast reconstructions with the attending in past 4 months. Intraoperative setbacks included anastomotic revisions, vessel damage, switching recipient vessels, or mastectomy flap defect. Major complications included operative takeback or flap loss.Among 291 surgeries (5 attendings, 2 hospitals), 35.1% were immediate, 77.3% used standard hemiabdominal DIEP flaps, 58.4% were bilateral, and 49.5% had prior radiation. Intraoperative setbacks occurred in 19.7%, major complications in 7.4%, average duration was 631.6 minutes, and supply costs averaged $5,216. Unfamiliar scrub-techs correlated with increased intraoperative setbacks (OR: 2.11, p < 0.05), particularly in early time intervals (T1: 1.91, p = 0.06; T2: 2.09, p < 0.05). Unfamiliar circulators correlated with increased supply costs (+12.2%, p < 0.05), especially in later time intervals (T2: +12.2%, p < 0.05; T3: +16.0%, p < 0.05). In addition to staff familiarity, at univariate level, intraoperative setbacks also correlated with prior radiation (p < 0.05), duration correlated with laterality, immediate reconstructions, mastectomy type, and anastomoses (p < 0.05), and costs correlated with anastomoses (p < 0.05). Multivariate analysis confirmed unfamiliar scrub-techs and circulators were significantly correlated with increased intraoperative setbacks and higher costs (p < 0.05), with a trend toward longer duration (p = 0.06).In microsurgical breast reconstruction, unfamiliar teams correlated with increased intraoperative setbacks, costs, and durations. Adjusting staffing models to prioritize familiarity may provide medical, financial, and logistical benefits.
This article, on the 60th anniversary of the journal Investigative Radiology , a journal dedicated to cutting-edge imaging technology, discusses key historical milestones in CT and MRI technology, as well as the ongoing advancement of contrast agent development for cardiovascular imaging over the past decades. It specifically highlights recent developments and the current state-of-the-art technology, including photon-counting detector CT and artificial intelligence, which will further push the boundaries of cardiovascular imaging. What were once ideas and visions have become today's clinical reality for the benefit of patients, and imaging technology will continue to evolve and transform modern medicine.
Manitoba experiences sexually transmitted and blood-borne infection (STBBI) incidence rates above the national average and fundamental public health sector responses face human resource constraints. Manitoba implemented a paraprofessional role, the Communicable Disease Technician (CD Tech), to complete low-complexity STBBI investigations and support STBBI testing, care engagement initiatives, provider reporting, harm reduction supply distribution, and community engagement. Secondary roles included tuberculosis directly observed treatment (DOT) and virtual DOT, and flu and COVID immunization support. Twenty CD Tech positions were allocated to regional public health teams along with additional Public Health Nurse (PHN) positions to support the role. Mixed methods were used to evaluate the impact on public health system capacity. Follow-up of chlamydia and gonorrhea case investigations increased from 35% to 98%. Volume of contacts followed by public health increased for chlamydia (114%), gonorrhea (33%), and HIV (68%). Health care provider reporting for cases of STBBI and treatment more than doubled (116%). No significant differences in case investigation data quality were found between CD Techs and PHNs. Qualitative interviews by public health staff (n = 24) found CD Techs highly flexible and competent team members who can fill gaps and expand capacity in direct client service, outreach, administration, data entry, or community/partner engagement. Mentorship, ongoing supervision, role clarity, training, and clear practice standards are required to optimize the role. There is potential to expand this innovation and build surge capacity in other areas of public health practice, and other public health jurisdictions. RéSUMé: CONTEXTE: Le Manitoba connaît un taux d’incidence des infections transmissibles sexuellement et par le sang (ITSS) supérieur à la moyenne nationale, et les interventions du secteur de la santé publique souffrent d’un manque de ressources humaines. INTERVENTION: Le Manitoba a instauré un rôle auxiliaire de technicien en maladies transmissibles pour réaliser les enquêtes sur les cas peu complexes d’ITSS et pour offrir une aide aux dépistages des ITSS, aux initiatives d’engagement en matière de soins, aux signalements des fournisseurs, à la distribution de fournitures de réduction des méfaits et à l’engagement communautaire. Leurs rôles secondaires consistaient notamment à offrir le traitement sous observation directe (TOD) par vidéo virtuels et en personne et à soutenir l’immunisation contre la COVID-19 et la grippe. Vingt postes de techniciens en maladies transmissibles ont été ouverts dans les équipes de santé publique régionales en plus de postes supplémentaires d’infirmière de la santé publique afin de les soutenir dans leur rôle. RéSULTATS: Une combinaison de méthodes a été utilisée pour évaluer l’incidence sur la capacité du système de santé publique. Le nombre d’enquêtes de suivi des cas de chlamydia et de gonorrhée est grimpé de 35% à 98%. Le nombre de contacts suivis par la santé publique a augmenté dans les cas de chlamydia (114%), de gonorrhée (33%) et de VIH (68%). Le nombre de fournisseurs de soins de santé produisant des rapports sur les cas d’ITSS et le traitement a plus que doublé (116%). Aucune différence importante de la qualité des données des enquêtes n’a été discernée entre celles des techniciens et celles du personnel infirmier de la santé publique. Des entrevues qualitatives réalisées par du personnel de la santé publique (n = 24) ont démontré que les techniciens en maladies transmissibles étaient des membres de l’équipe très flexibles et compétents qui sont capables de combler les écarts et d’accroître la capacité en matière de service à la clientèle direct, de sensibilisation, d’administration, de saisie de données ou d’engagement auprès de la collectivité et des partenaires. CONSéQUENCES: Des mentorats, une surveillance constante, des précisions au sujet du rôle, de la formation et des normes de pratiques claires sont requis afin d’optimiser le rôle. Il est possible d’accroître cette innovation et de renforcer la capacité de mobilisation dans d’autres domaines de pratique de la santé publique et dans d’autres instances de santé publique.
Elevated repeat-scanning rates are reported for CT pulmonary angiography (CTPA). Individualised protocols optimise contrast- and radiation-doses, but whether this affects repeat scanning is unknown. The current study evaluates repeat-CTPA in a 24/7, state-of-the-art clinical-care setting. This is a retrospective observational single-centre study of consecutive CTPA acquired over a 5-year period during standard clinical care. The primary outcome is the repeat-scan rate. Repeat- and single-scan groups were compared for initial-scan characteristics (patient-related, CT-scanner, contrast-administration, kV-settings, regular hours/shifts, radiation-dose), and cumulative contrast- and radiation-doses. An expert radiologist panel retrospectively evaluated probable reasons for repeat scanning through visual, subjective assessment of initial-scan images. CTPA repeat rate was 3.1% (139/4467). Repeat- and single-scan groups significantly differed: age (55 ± 18 vs. 63 ± 17 years; p < 0.001), Body Mass Index (27 kg/m2 (IQR 7) vs. 25 kg/m2 (IQR 6); p = 0.022), radiation-dose (141 mGy∙cm (IQR 73) vs. 121 mGy∙cm (IQR 70); p < 0.001). Cumulative contrast- and radiation-doses were: 96 mL (IQR 31) vs. 48 mL (IQR 22) (p < 0.001); 0.36 gI/kg (IQR 0.11) vs. 0.18 gI/kg (IQR 0.51) (p < 0.001); 272 mGy∙cm (IQR 69) vs. 121 mGy∙cm (IQR 70) (p < 0.001). Retrospective expert-consensus reasons for repeat scanning were: 31/133 patient-related; 28/133 multifactorial; 12/133 contrast/scan-protocol; 4/133 operator-error; 2/133 unidentified. 56/133 (42%) initial scans were retrospectively deemed diagnostic-quality, and these significantly differed from other repeat-categories in patient characteristics age (51 ± 15 vs. 57 ± 19 years; p = 0.045) and sex (64.3% vs. 50.6% female; p = 0.045), and in contrast volume (48 mL (IQR 17) vs. 46 mL (IQR 24); p = 0.031). Individualised scan protocols yielded diagnostic images around the clock, with repeat scanning well within ranges published in the literature. Retrospective expert evaluation suggests repeat rates as low as 1.2% may be possible. Repeat- and single-scan groups significantly differed in patient characteristics, and repeat-scanning reasons were mostly patient-related. These results suggest further tailoring protocols to (younger, female) patients might be beneficial in helping to further reduce CTPA-repeats. Question CT pulmonary angiography (CTPA) is subject to relatively high repeat-scanning rates, but it is not known how state-of-the-art CTPA and individualised protocols perform in clinical practice today. Findings During 5 years of clinical practice the repeat rate was 3%; retrospective expert image-evaluation suggests a repeat rate as low as 1.2% may be possible. Clinical relevance Repeat- and single-scan groups significantly differed in patient characteristics, and reasons for repeat scanning were mostly patient-related. Further tailoring protocols to (younger, female) patients may be the best focus to help reduce CTPA-repeats, improve safety, and reduce logistic burden.