All aspects of the arthroplasty pathway must be scrutinized to maximize value and eliminate unnecessary cost. Radiology providers’ contracts with hospitals often call for readings of all radiographs. ...This policy has little effect on patient care when intraoperative radiographs are taken and used to make real-time decisions. In order to determine the value of radiologist overreads, we asked 3 questions: what was the delay between the time an intraoperative radiograph was taken and time the report was generated, were the overreads accurate, and what is the associated cost?
Two hundred hip and knee radiograph reports generated over 6 months during 391 cases were reviewed. The time the report was dictated was compared to the time taken and time of surgery completion. To determine accuracy, each overread was rated as accurate or inaccurate. The cost of the overread was determined by multiplying the number of radiographs times the radiology fee less the technical fee.
Median delay between taking the radiograph and filing the report was 45 minutes (range, 0-9778 minutes). Only 31.5% were filed before completion of the procedure. And 18.0% (36/200) were considered inaccurate despite lenient criteria. The reading fee for hip radiographs was $52.00, and for knee radiographs was $38.00, representing a total cost of $10,182 in our select series. This cost projects to $43,614 annually at our facility.
Radiology overreads of intraoperative radiographs have no effect on real-time decision-making. In the era of value-based care, payors should stop paying for overreads and reimburse providers who actually read the films intraoperatively.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Zebrafish (
Danio rerio
) as a model research organism continues to expand its relevance and role in multiple research disciplines, with recent work directed toward models of metabolism, nutrition, ...and energetics. Multiple technologies exist to assess body composition in animal research models at various levels of detail (tissues/organs, body regions, and whole organism). The development and/or validation of body composition assessment tools can open new areas of research questions for a given organism. Using fish from a comparative nutrition study, quantitative magnetic resonance (QMR) assessment of whole body fat and fat-free mass (FFM) in live fish was performed. QMR measures from two cohorts (
n
= 26 and
n
= 27) were compared with chemical carcass analysis (CCA) of FM and FFM. QMR was significantly correlated with chemical carcass values (fat,
p
< 0.001; lean,
p
= 0.002), although QMR significantly overestimated fat mass (FM) (0.011 g;
p
< 0.0001) and underestimated FFM (−0.024 g;
p
< 0.0001) relative to CCA. In a separate cross-validation group of fish, prediction equations corrected carcass values for FM (
p
= 0.121) and FFM (
p
= 0.753). These results support the utilization of QMR—a nonlethal nondestructive method—for cross-sectional or longitudinal body composition assessment outcomes in zebrafish.
Data from wearable technology may correlate with patient-reported outcome measures (PROMs). The objective of this prospective pilot study of 22 total joint arthroplasty patients was to determine if ...sensor-generated data are predictive of short-term PROMs in total joint arthroplasty. Data on “average daily step count” and “average daily minutes active” were generated by the provided wearable sensor preoperatively and up to 6 weeks postoperatively. PROMs were collected preoperatively and at 6 weeks postoperatively. Changes in PROMs were calculated as “Δ”. Linear regression of the sensor data and PROMs generated R2 values. Changes in the average daily step count from preop to 6-week postop strongly associated with changes in Veterans Rand 12 Physical Component Score (R2 = 0.4532) from preop to 6 weeks. Changes in average daily minutes active from preop to 6-weeks postop were strongly associated with ΔHOOS/KOOS (R2 = 0.4858).
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The value of the zebrafish (
Danio rerio
) as a model organism continues to expand. In developing the model, current feeding practice in zebrafish laboratories includes the use of commercially ...available diets. In this study, we compared outcomes in growth, body composition, and reproduction among zebrafish fed five highly utilized commercial diets and one formulated chemically defined reference diet. Wild-type zebrafish larvae were raised on live feed until 21 days postfertilization and then fed diets for 16 weeks. All fish received a daily ration of >5% of body weight (adjusted biweekly). Growth varied among diets throughout the feeding trial, and at study termination (week 16), significant differences among diets were observed for terminal weight gain, body condition index, body fat deposition, and reproductive outcomes. In addition, the proportion of viable embryos produced from females fed the formulated reference diet was high relative to the commercial diets. These data suggest that metabolic profiles, most likely reflecting nutrient/energy availability, utilization, and allocation, vary relative to diet in zebrafish. Undefined differences in metabolic profiles could result in erroneous predictions of health outcomes and make comparisons among laboratories more challenging. We recommend that dietary standards should be defined for zebrafish to support their common utility in biomedical research.
Our understanding of how checkpoint inhibitors (CPI) affect T cell evolution is incomplete, limiting our ability to achieve full clinical benefit from these drugs. Here we analyzed peripheral T cell ...populations after one cycle of CPI and identified a dynamic awakening of the immune system revealed by T cell evolution in response to treatment. We sequenced T cell receptors (TCR) in plasma cell-free DNA (cfDNA) and peripheral blood mononuclear cells (PBMC) and performed phenotypic analysis of peripheral T cell subsets from metastatic melanoma patients treated with CPI. We found that early peripheral T cell turnover and TCR repertoire dynamics identified which patients would respond to treatment. Additionally, the expansion of a subset of immune-effector peripheral T cells we call T
cells correlated with response. These events are prognostic and occur within 3 weeks of starting immunotherapy, raising the potential for monitoring patients responses using minimally invasive liquid biopsies."
The importance of nutritional components on growth and body composition outcomes has been demonstrated in multiple model organisms. Although zebrafish (
Danio rerio
) have an established role in ...research laboratories for its utility in understanding developmental biology and genetics, the influence of diet composition on basic growth outcomes is less well demonstrated. In the current study, four protein sources were tested in isolation using isonitrogenous diets or combined using a defined lab diet. Fish (
n
≈60/group) were group housed (
n
≤10 fish/1.8 L tank) and fed
ad libitum
three times daily for 12 weeks. Fish were assessed for effects on length, body weight, and body composition (lean and fat mass). Individuals fed wheat gluten protein were significantly shorter in length, with significantly lower body weight and lean mass in both male and female fish, although percent body fat was high compared with other diets. Casein-fed fish similarly had significantly reduced body length, body weight, and lean and fat mass in both male and female fish, with a low percent body fat compared with other diets (leanest). Fish protein hydrolysate-fed fish had significantly lower lean mass and a high percent body fat, whereas soy protein isolate diet performed similarly to a mixed-protein control diet for all measured outcomes. These results suggest that the protein source, with accompanying amino acid ratios or additional protein source differences, has a significant impact on growth and body composition outcomes in zebrafish when fed in a semipurified, defined diet background.
Library-sponsored grants to faculty can enable greater collaboration in the development of Internet resources. Funding strategies can be based on reallocation of a percentage of the materials budget. ...Description of how to structure an internal grant program along with details of what should be contained in a call for proposals in order to solicit faculty interest are provided.
Full text
Available for:
BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
PDF
