William C. Yarbrough

Accuracy of remote chest X-ray interpretation using Google Glass technology

OBJECTIVES We sought to explore the accuracy of remote chest X-ray reading using hands-free, wearable technology (Google Glass, Google, Mountain View, California). METHODS We compared interpretation of twelve chest X-rays with 23 major cardiopulmonary findings by faculty and fellows from cardiology, radiology, and pulmonary-critical care via: (1) viewing the chest X-ray image on the Google Glass screen; (2) viewing a photograph of the chest X-ray taken using Google Glass and interpreted on a mobile device; (3) viewing the original chest X-ray on a desktop computer screen. One point was given for identification of each correct finding and a subjective rating of user experience was recorded. RESULTS Fifteen physicians (5 faculty and 10 fellows) participated. The average chest X-ray reading score (maximum 23 points) as viewed through the Google Glass, Google Glass photograph on a mobile device, and the original X-ray viewed on a desktop computer was 14.1±2.2, 18.5±1.5 and 21.3±1.7, respectively (p<0.0001 between Google Glass and mobile device, p<0.0001 between Google Glass and desktop computer and p=0.0004 between mobile device and desktop computer). Of 15 physicians, 11 (73.3%) felt confident in detecting findings using the photograph taken by Google Glass as viewed on a mobile device. CONCLUSION Remote chest X-ray interpretation using hands-free, wearable technology (Google Glass) is less accurate than interpretation using a desktop computer or a mobile device, suggesting that further technical improvements are needed before widespread application of this novel technology.

Human natural killer cells enhance a mixed leukocyte reaction

Natural killer cells (NK) have been reported to down‐regulate the initiation of T cell responses in animal models. In the current study, highly purified CD16 + human NK cells were obtained by cell sorting and their effect on the stimulation of allogeneic T cells (MLR) determined. NK cells did not directly stimulate T cell proliferation. However, when added to a population of loosely adherent mononuclear cells (LAM), NK enhanced the ability of these accessory cells to stimulate T proliferation. This effect was not reproduced by the addition of sorted CD5 + T cells, sorted CD16 – cells, or control lymphocytes to the MLR. The effect of NK on the MLR was not restricted by class II antigens and was similar to the effect of adding IL‐1 to MLR cultures. These results demonstrate that human NK cells are capable of enhancing a T cell response.

Assessment of the Intensive Care Unit Treatment of Pneumonia at a Veterans Affairs Facility

Introduction Pneumonia is a common cause of morbidity and mortality in the critically ill. Clinicians use a range of duration for antibiotic treatment from 7 to 14 days or longer. Failure to de-escalate antimicrobial therapy in a timely manner may lead to increased antimicrobial resistance, increased risk of side effects, and increased cost. Objective To investigate potential methods to improve treatment of pneumonia for patients in 4 intensive care units (ICUs). Methods A retrospective descriptive chart review was conducted at the Veterans Affairs North Texas Health Care System (VANTHCS). Veterans aged 18 to 90 years admitted to the ICU with a diagnosis of pneumonia were included. Descriptive statistics were used to interpret the data. Current management was reviewed to identify markers such as length of antibiotic therapy, ICU length of stay, and inpatient mortality. Secondary objectives included appropriateness and accuracy of the empiric regimen. Results Of the 1,854 Veterans admitted, 107 met inclusion criteria. Antibiotic choices for positive cultures were appropriate in 45 out of 46 (98%) patients, with an average length of therapy of 8.6 ± 6.3 days. De-escalation of antibiotics based on sensitivity data occurred in 73% of positive cultures. Conclusions Pneumonia in the VANTHCS ICUs is initially treated with empiric antibiotics. Empiric antibiotic therapy for pneumonia was appropriate and accurate over this time period. Opportunities exist for de-escalation in patients with or without positive cultures. The procalcitonin assay is now being utilized at VANTHCS to optimize patient care.