This study aimed to determine health care disparities in evaluation and admission among underserved racial and ethnic minority groups presenting with cardiovascular complaints during the first ...postpartum year according to patient and provider demographics.
A retrospective cohort study was performed on all postpartum patients who sought emergency care between February 2012 and October 2020 in a large urban care center in Southeastern Texas. Patient information was collected according to International Classification of Diseases 10th Revision codes and individual chart analysis. Race, ethnicity, and gender information were self-reported for both patients on hospital enrollment forms and emergency department (ED) providers on their employment records. Statistical analysis was performed with logistic regression and Pearson's chi-square test.
Of 47,976 patients who delivered during the study period, 41,237 (85.9%) were black, Hispanic, or Latina and 490 (1.1%) presented to the ED with cardiovascular complaints. Baseline characteristics were similar between groups; however, Hispanic or Latina patients were more likely to have had gestational diabetes mellitus during the index pregnancy (6.2 vs. 18.3%). There was no difference in hospital admission between groups (17.9% black vs. 16.2% Latina or Hispanic patients). There was no difference in the hospital admission rate by provider race or ethnicity overall (
= 0.82). There was no difference in the hospital admission rate when a patient was evaluated by a provider of a different race or ethnicity (relative risk RR = 1.08, CI: 0.6-1.97). There was no difference in the rate of admission according to the self-reported gender of the provider (RR = 0.97, CI: 0.66-1.44).
This study illustrates that disparities did not exist in the management of racial and ethnic minority groups who presented to the ED with cardiovascular complaints during the first postpartum year. Patient-provider discordance in race or gender was not a significant source of bias or discrimination during the evaluation and treatment of these patients.
· Adverse postpartum outcomes disproportionately affect minorities.. · There was no difference in admissions between minority groups.. · There was no difference in admissions by provider race and ethnicity..
Cervical ribs are congenital variants that are known to cause TOS or brachial plexopathy in up to 10% of the affected individuals. We investigated how often cervical ribs are present on cervical ...spine CT scans to determine the incidence in humans and the percentage of reported cervical ribs.
Cervical spine CT scans and the reports of 3404 consecutive adult patients were retrospectively reviewed to determine the presence of cervical ribs and whether they had been reported.
Cervical ribs were found in 2.0% (67/3404) of the population. Of the 67 patients with cervical ribs, 27 (40.3%) had bilateral ribs. The prevalence of cervical ribs in women was twice that in men, 2.8% (39/1414) versus 1.4% (28/1990). Although African Americans accounted for 50.1% (1706/3404) and whites, 41.2% (1402/3404) of the patient population, African Americans were 70.1% (47/67) of patients with cervical ribs, whereas whites were 26.9% (18/67). Radiologists commented on 25.5% (24/94) of the cervical ribs in 25.4% (27/67) of patients.
The prevalence of cervical ribs in the human population has been a source of uncertainty due to the degree of difficulty that comes in detecting this often subtle congenital variation. In our sample, the prevalence was 2.0% of patients. Our study determined that cervical ribs are underreported in patients undergoing cervical spine CT. Given the potential clinical implications of these anatomic variants, neuroradiologists must be more meticulous in identifying cervical ribs when reviewing cervical spine CT scans.
Prior studies have found a 2%-8% clinically significant error rate in radiology practice. We compared discrepancy rates of studies interpreted by subspecialty-trained neuroradiologists working with ...and without trainees.
Subspecialty-trained neuroradiologists reviewed 2162 studies during 41 months. Discrepancies between the original and "second opinion" reports were scored: 1, no change; 2, clinically insignificant detection discrepancy; 3, clinically insignificant interpretation discrepancy; 4, clinically significant detection discrepancy; and 5, clinically significant interpretation discrepancy. Faculty alone versus faculty and trainee discrepancy rates were calculated.
In 87.6% (1894/2162), there were no discrepancies with the original report. The neuroradiology division had a 1.8% (39/2162; 95% CI, 1.3%-2.5%) rate of clinically significant discrepancies. In cases reviewed solely by faculty neuroradiologists (16.2% = 350/2162 of the total), the rate of discrepancy was 1.7% (6/350). With fellows (1232/2162, 57.0% of total) and residents (580/2162, 26.8% of total), the rates of discrepancy were 1.6% (20/1232) and 2.2% (13/580), respectively. The odds of a discrepant result were 26% greater (OR = 1.26; 95% CI, 0.38-4.20) when reading with a resident and 8% less (OR = 0.92; 95% CI, 0.35-2.44) when reading with a fellow than when reading alone.
There was a 1.8% rate of clinically significant detection or interpretation discrepancy among academic neuroradiologists. The difference in the discrepancy rates between faculty only (1.7%), fellows and faculty (1.6%), and residents and faculty (2.2%) was not statistically significant but showed a trend indicating that reading with a resident increased the odds of a discrepant result.
Geiger-mode Avalanche Photodiodes (G-APD) bear the potential to significantly improve the sensitivity of Imaging Air Cherenkov Telescopes (IACT). We are currently building the First G-APD Cherenkov ...Telescope (FACT) by refurbishing an old IACT with a mirror area of 9.5 square meters and are constructing a new, fine-pixelized camera using novel G-APDs. The main goal is to evaluate the performance of a complete system by observing very high energy gamma-rays from the Crab Nebula. This is an important field test to check the feasibility of G-APD-based cameras to replace at some time the PMT-based cameras of planned future IACTs like AGIS and CTA. In this article, we present the basic design of such a camera as well as some important details.
A precision measurement by the Alpha Magnetic Spectrometer on the International Space Station of the positron fraction in primary cosmic rays in the energy range from 0.5 to 350 GeV based on 6.8 × ...10(6) positron and electron events is presented. The very accurate data show that the positron fraction is steadily increasing from 10 to ∼ 250 GeV, but, from 20 to 250 GeV, the slope decreases by an order of magnitude. The positron fraction spectrum shows no fine structure, and the positron to electron ratio shows no observable anisotropy. Together, these features show the existence of new physical phenomena.
Results of the prototype camera for FACT Anderhub, H.; Backes, M.; Biland, A. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
05/2011, Letnik:
639, Številka:
1
Journal Article
Recenzirano
The maximization of the photon detection efficiency (PDE) is a key issue in the development of cameras for Imaging Atmospheric Cherenkov Telescopes. Geiger-mode Avalanche Photodiodes (G-APD) are a ...promising candidate to replace the commonly used photomultiplier tubes by offering a larger PDE and in addition a facilitated handling. The FACT (First G-APD Cherenkov Telescope) project evaluates the feasibility of this change by building a camera based on 1440 G-APDs for an existing small telescope. As a first step towards a full camera, a prototype module using 144 G-APDs was successfully built and tested. The strong temperature dependence of G-APDs is compensated using a feedback system, which allows to keep the gain of the G-APDs constant to 0.5%.
A G-APD based Camera for Imaging Atmospheric Cherenkov Telescopes Anderhub, H.; Backes, M.; Biland, A. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
02/2011, Letnik:
628, Številka:
1
Journal Article
Recenzirano
Imaging Atmospheric Cherenkov Telescopes (IACT) for Gamma-ray astronomy are presently using photomultiplier tubes as photo sensors. Geiger-mode avalanche photodiodes (G-APD) promise an improvement in ...sensitivity and, important for this application, ease of construction, operation and ruggedness. G-APDs have proven many of their features in the laboratory, but a qualified assessment of their performance in an IACT camera is best undertaken with a prototype. This paper describes the design and construction of a full-scale camera based on G-APDs realized within the FACT project (First G-APD Cherenkov Telescope).
The Joint Commission has identified timely reporting of critical results as one of the National Patient Safety Goals. We surveyed directors of neuroradiology fellowships to assess and compare ...critical findings lists across programs.
A 3-question survey was e-mailed to directors of neuroradiology fellowships with the following questions: 1) Do you currently have a "critical findings" list that you abide by in your neuroradiology division? 2) How is that list distributed to your residents and fellows for implementation, if at all? and 3) Was this list vetted by neurology, neurosurgery, and otolaryngology departments? Programs with CF lists were asked for a copy of the list. Summary and comparative statistics were calculated.
Fifty-one of 89 (57.3%) programs responded. Twenty-one of 51 (41.2%) programs had CF lists. Lists were distributed during orientation, sent via Web sites and e-mails, and posted in work areas. Eleven of 21 lists were developed internally, and 5 of 21, with the input from other departments. The origin of 5 of 21 lists was unknown. Forty CF entities were seen in 20 submitted lists (mean, 9.1; range, 2-23). The most frequent entities were the following: cerebral hemorrhage (18 of 20 lists), acute stroke (15 of 20), spinal cord compression (15 of 20), brain herniation (12 of 20), and spinal fracture/instability (12 of 20). Programs with no CF lists called clinicians on the basis of "common sense" and "clinical judgment."
Less than a half (41.2%) of directors of neuroradiology fellowships that responded have implemented CF lists. CF lists have variable length and content and are predominantly developed by radiology departments without external input.
The objective of our study was to assess compliance among academic neuroradiologists in reporting institutionally derived critical findings.
We analyzed 3054 neuroradiology CT and MRI reports ...generated in 1 month. Reports were categorized by whether or not they contained a critical finding based on a previously established list. The reports were subcategorized by whether the reporting neuroradiologist flagged the report as containing a critical finding and whether the radiologist verbally communicated the critical finding to the referring clinician. Reports were divided into day or night categories and the frequency of critical findings for each time period was calculated.
Of the 3054 reports included in this study, 301 (9.9%) had critical findings. Of those 301 reports, 233 (77.4%) were flagged and the referring clinician was called. Of the remaining 68 reports with critical findings, the reporting radiologist did not call the clinician about 35.3% of them (24/68). Of the 2753 reports without critical findings, 2658 (96.5%) were appropriately not flagged and the clinician was not called. However, radiologists called clinicians about 3.5% (95/2753) of the reports without critical findings and erroneously flagged 68.4% (65/95) of those reports as critical. A majority of the cases with critical findings were reported at night (55.1%) despite the fact that 67.2% of the studies occurred during the day.
Compliance with reporting and communicating critical findings must be monitored. Calling clinicians to report noncritical findings may result in unnecessary interruptions in work flow for radiologists and referring health care providers.
PDF
