Kirsteen R. Burton

The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis

This review appraises the process of development and the measurement properties of the Pittsburgh sleep quality index (PSQI), gauging its potential as a screening tool for sleep dysfunction in non-clinical and clinical samples; it also compares non-clinical and clinical populations in terms of PSQI scores. MEDLINE, Embase, PsycINFO, and HAPI databases were searched. Critical appraisal of studies of measurement properties was performed using COSMIN. Of 37 reviewed studies, 22 examined construct validity, 19 - known-group validity, 15 - internal consistency, and three - test-retest reliability. Study quality ranged from poor to excellent, with the majority designated fair. Internal consistency, based on Cronbachs alpha, was good. Discrepancies were observed in factor analytic studies. In non-clinical and clinical samples with known differences in sleep quality, the PSQI global scores and all subscale scores, with the exception of sleep disturbance, differed significantly. The best evidence synthesis for the PSQI showed strong reliability and validity, and moderate structural validity in a variety of samples, suggesting the tool fulfills its intended utility. A taxonometric analysis can contribute to better understanding of sleep dysfunction as either a dichotomous or continuous construct.

A population-based study of the epidemiology of acute adult burn injuries in the Calgary Health Region and factors associated with mortality and hospital length of stay from 1995 to 2004.

INTRODUCTION Trauma resulting from acute burns is relatively common and we wished to study the incidence, outcomes and factors related to mortality and hospital length of stay to identify potential areas of prevention and improve the care of burn-injured patients. To do so, we studied a population of adult burn injury patients from a large area of Canada (the Calgary Health Region (CHR) over a 10-year period. Burn data from this population-based sample has never been published and is not currently included in the American Burn Association Repository report. METHODS We extracted data on all adult (>or=18 years) residents of the CHR who suffered a burn injury requiring hospital admission between January 1995 and December 2004. Of particular interest were patient demographics, incidence and mortality rates of the victims as well as any factors that were associated with mortality or increased length of hospital stay. RESULTS A total of 928 burn-injured patients were identified. The highest incidence of burn injury admissions in the CHR occurred in 1996 (12.2 burn injury admissions per 100,000 population) and 2004 (12.3 admissions per 100,000 population). The largest number of burn injury admissions occurred during the months of July and August (23.3%), while the fewest occurred during the winter months of February and December (11.9%). Mean patient age was 45.2 years (range 18-97) and 658 (70.9%) were male. The majority of our patients were admitted with second-degree burns (48.7%) and burns of the head and neck were the most prevalent (22.2%). The mean length of hospital stay for burn patients was 20.4 days (range 1-312). Over the course of the 10 years of the study, 9 (1.0%) burn patients died during their hospital stay. In univariate analyses, burn survivors differed significantly from non-survivors with respect to mean age, burn degree, body part burned and year of admission. In adjusted analyses, survivors and non-survivors differed significantly with respect to year and month of admission, degree of burn, patient age and length of stay. Factors significantly associated with increase length of hospital stay included degree of burn, older patient age and hospital site. CONCLUSIONS In this Canadian health region, patients who die from burns tend to be older, present to the hospital during the winter months, and suffer more acute burns to the torso or multiple body regions. Additionally, patient length of stay is influenced by older patient age and greater burn thickness.

Methods and Challenges in Quantitative Imaging Biomarker Development

Academic radiology is poised to play an important role in the development and implementation of quantitative imaging (QI) tools. This article, drafted by the Association of University Radiologists Radiology Research Alliance Quantitative Imaging Task Force, reviews current issues in QI biomarker research. We discuss motivations for advancing QI, define key terms, present a framework for QI biomarker research, and outline challenges in QI biomarker development. We conclude by describing where QI research and development is currently taking place and discussing the paramount role of academic radiology in this rapidly evolving field.

Clinical Utility of Quantitative Imaging

Quantitative imaging (QI) is increasingly applied in modern radiology practice, assisting in the clinical assessment of many patients and providing a source of biomarkers for a spectrum of diseases. QI is commonly used to inform patient diagnosis or prognosis, determine the choice of therapy, or monitor therapy response. Because most radiologists will likely implement some QI tools to meet the patient care needs of their referring clinicians, it is important for all radiologists to become familiar with the strengths and limitations of QI. The Association of University Radiologists Radiology Research Alliance Quantitative Imaging Task Force has explored the clinical application of QI and summarizes its work in this review. We provide an overview of the clinical use of QI by discussing QI tools that are currently used in clinical practice, clinical applications of these tools, approaches to reporting of QI, and challenges to implementing QI. It is hoped that these insights will help radiologists recognize the tangible benefits of QI to their patients, their referring clinicians, and their own radiology practice.

The Evolving Role of the Radiologist: The Vancouver Workload Utilization Evaluation Study

PURPOSE The role of the present-day on-site hospital radiologist surpasses image interpretation-related duties. This study characterizes these workload activities, as well as quantifies the type of value-based interactions radiologists experience on a daily basis with allied health personnel. MATERIALS AND METHODS A prospective, observational, randomized study was performed across 3 hospitals in the fall of 2012. One month of observation of 14 staff radiologists was performed by a trained observer. The observer followed the subject radiologists throughout the workday, recording activities using a time and motion methodology. RESULTS Radiologists spent 36.4% of their time on image interpretation. The proportion of noninterpretative tasks was 43.8%, which includes activities such as protocolling requisitions, supervising and monitoring studies, performing image-guided procedures, consulting with physicians, and directly caring for patients. Total clinical productivity was 87.7%, and radiologists experienced, on average, 6 interactions per hour with other health personnel, of which over 81.2% directly influenced patient care in real time. CONCLUSION This study demonstrates a new framework of characterizing the type of work radiologists perform on a daily basis, which helps further define the evolving role of the present-day radiologist to other physicians, administrators, and policy makers. Furthermore, the on-site added value that radiologists deliver suggests that radiologists are central figures in the medical imaging department who are difficult to replace by off-site or nonradiologist image interpreters.

Relevance of Electronic Health Information to Doctors in the Developing World: Results of the Ptolemy Project’s Internet-based Health Information Study (IBHIS)

The aim of this study was to determine the current usage, relevance, and preferences for electronic health information (EHI) in the participant surgeons’ clinical, research, and teaching activities. The Internet-Based Health Information Survey (IBHIS) was conducted from August to December 2003. Thirty-seven doctors (primarily practicing in East Africa) participated, all of whom had been using the Ptolemy resources for at least 6 months. Survey questions concerned time spent reading medical literature, preferred information sources, preferred type of publication, relevance, preference for western versus local medical literature, and academic productivity. Among the 75 eligible participants, 37 (48%) responded. From these responses it was found that African surgeons with access to EHI read more than articles than they did before they had such access, and they find that the information obtained is highly relevant to their clinical, teaching, and research activities. They prefer electronic journals to textbooks and are more inclined to change their practice based on information found in western journals than local journals. Ptolemy resources helped the respondents who reported academic work write a total of 33 papers for presentation or publication. Overall, access to EHI enables doctors in Africa to read more, is relevant, and contributes directly to academic productivity; thus Western medical literature is useful in the developing world, and EHI delivery should continue to expand.

Opportunities for Patient-centered Outcomes Research in Radiology

Recently created in 2010, the Patient-Centered Outcomes Research Institute (PCORI) supports patient-centered comparative effectiveness research with a focus on prioritizing high-impact studies and improving trial design methodology. The Association of University Radiologists Radiology Research Alliance Task Force on patient-centered outcomes research in Radiology aims to review recently funded imaging-centric projects that adhere to the methodologies established by PCORI. We provide an overview of the successful application of PCORI standards to radiology topics, highlight how these methodologies differ from other forms of radiology research, and identify opportunities for new projects as well as potential barriers for involvement. Our hope is that review of specific case examples in radiology will clarify the use and value of PCORI methods mandated and supported nationally by the Affordable Care Act.

Economic Evaluations in the Diagnosis and Management of Traumatic Brain Injury: A Systematic Review and Analysis of Quality

BACKGROUND Economic evaluations provide a unique opportunity to identify the optimal strategies for the diagnosis and management of traumatic brain injury (TBI), for which uncertainty is common and the economic burden is substantial. OBJECTIVE The objective of this study was to systematically review and examine the quality of contemporary economic evaluations in the diagnosis and management of TBI. METHODS Two reviewers independently searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment Database, EconLit, and the Tufts CEA Registry for comparative economic evaluations published from 2000 onward (last updated on August 30, 2013). Data on methods, results, and quality were abstracted in duplicate. The results were summarized quantitatively and qualitatively. RESULTS Of 3539 citations, 24 economic evaluations met our inclusion criteria. Nine were cost-utility, five were cost-effectiveness, three were cost-minimization, and seven were cost-consequences analyses. Only six studies were of high quality. Current evidence from high-quality studies suggests the economic attractiveness of the following strategies: a low medical threshold for computed tomography (CT) scanning of asymptomatic infants with possible inflicted TBI, selective CT scanning of adults with mild TBI as per the Canadian CT Head Rule, management of severe TBI according to the Brain Trauma Foundation guidelines, management of TBI in dedicated neurocritical care units, and early transfer of patients with TBI with nonsurgical lesions to neuroscience centers. CONCLUSIONS Threshold-guided CT scanning, adherence to Brain Trauma Foundation guidelines, and care for patients with TBI, including those with nonsurgical lesions, in specialized settings appear to be economically attractive strategies.

Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography

OBJECTIVE To evaluate the impact of an emergency department (ED) automatic preauthorization policy on after-hours utilization of neuroradiology computed tomography (CT). METHODS All CT studies of the head with contrast facial bones, orbits, spine, and neck requested through the ED and performed between January 1, 2004, and December 31, 2010, were reviewed. The preauthorization policy was instituted on February 25, 2008. A control group of noncontrast CT head studies was used for comparison. Pre- and postpolicy implementation utilization rates were compared between the control group of noncontrast CT head studies and the study group neuroradiology CT studies. RESULTS During the study period, 408,501 ED patient visits occurred and 20,703 neuroradiology CT studies were carried out. The pre- and postimplementation groups of noncontrast CT head scans totalled 7,474 and 6,094, respectively, whereas the pre- and postimplementation groups of all other neuroradiology CT studies totalled 3,833 and 3,302, respectively. The CT utilization between the two groups did not differ significantly: the noncontrast head group pre- and postpolicy implementation increased by 0.31 to 3.41%, whereas the utilization of all other neuroradiology CT studies increased by 0.22 to 1.84% (p value  =  0.061 for a difference between groups). CONCLUSION Implementation of an automatic preauthorization policy for after-hours neuroradiology CT studies did not result in a statistically significant increase in CT utilization. This suggests that concerns regarding the negative effects of such policies may be unfounded, and further research in this area is warranted.

Another Time, Another Space: The Evolution of the Virtual Journal Club.

Virtual journal clubs (VJCs) provide a standardized, easily accessible forum for evidence-based discussion. The new virtual reality setting in which journal clubs and other online education events now take place offers great advantages and new opportunities for radiologists in academic medicine and private practice. VJCs continue to evolve, largely due to many emerging technologies and platforms. VJCs will continue to play an increasingly important role in medical education, interdisciplinary interaction, and multi-institutional collaboration. In this article, we discuss how to conduct and lead a critical review of medical literature in the setting of a virtual or traditional journal club. We discuss the current applications of VJCs in medical and graduate medical education and continued lifelong learning. We also explain the advantages and disadvantages of VJCs over traditional venues. Finally, the reader will be given the tools to successfully implement and run a VJC.