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McLaughlin C, Moorman SEH, Yin C, Shankar PR, Davenport MS, Neal CH, Pinsky RW, Pujara AC. Continuity of Radiologists Between Diagnostic Breast Imaging and Image-Guided Breast Biopsy: Impact on Patient-Reported Biopsy Morbidity Experiences. J Breast Imaging 2024; 6:141-148. [PMID: 38170567 DOI: 10.1093/jbi/wbad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To determine whether continuity of care between diagnostic breast imaging and subsequent image-guided breast biopsy could reduce patient-reported biopsy-related morbidity. METHODS This was a prospective, pragmatically randomized, 2-arm health utilities analysis of 200 women undergoing diagnostic breast imaging followed by US- or stereotactic-guided breast biopsy at a single quaternary care center from September 3, 2019, to April 10, 2023. Breast biopsy-naive women with a BI-RADS 4 or 5 finding at diagnostic imaging were randomly scheduled for the typically first available biopsy appointment. One day after biopsy, enrolled patients were administered the Testing Morbidities Index (TMI). The primary outcome was the difference in TMI summary utility scores in patients who did vs did not have the same radiologist perform diagnostic imaging and biopsy. RESULTS Response rates were 63% (100/159) for the different radiologist cohort and 71% (100/140) for the same radiologist cohort; all respondents answered all questions in both arms. Mean time to biopsy was 7 ± 6 days and 10 ± 9 days, and the number of participating radiologists was 11 and 18, respectively. There was no difference in individual measured domains (pain, fear, or anxiety before procedure; pain, embarrassment, fear, or anxiety during procedure; mental or physical impact after procedure; all P >.00625) or in overall patient morbidity (0.83 [95% CI, 0.81-0.85] vs 0.82 [95% CI: 0.80-0.84], P = .66). CONCLUSION Continuity of care between diagnostic breast imaging and image-guided breast biopsy did not affect morbidity associated with breast biopsy, suggesting that patients should be scheduled for the soonest available biopsy appointment rather than waiting for the same radiologist.
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Affiliation(s)
| | | | - Chen Yin
- Inland Imaging, Spokane, WA, USA
| | - Prasad R Shankar
- Michigan Medicine, Department of Radiology, Ann Arbor, MI, USA
- Cleveland Clinic, Imaging Institute, Cleveland, OH, USA
| | | | - Colleen H Neal
- Michigan Medicine, Department of Radiology, Ann Arbor, MI, USA
| | - Renee W Pinsky
- Michigan Medicine, Department of Radiology, Ann Arbor, MI, USA
| | - Akshat C Pujara
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA, USA
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O'Donohue LS, Friedland MH, Shankar PR, Gonzalez-Cabezas C, Flannagan SE, Aronovich S, Masotti M, Bornschein RE, Davenport MS. Direct Quantification of Gadolinium Retention in Young Patients by ICP-MS Analysis of Extracted Teeth. AJR Am J Roentgenol 2024. [PMID: 38506538 DOI: 10.2214/ajr.24.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Laura S O'Donohue
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109
| | - Matthew H Friedland
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109
| | - Prasad R Shankar
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44194
| | | | - Susan E Flannagan
- School of Dentistry, University of Michigan, 1011 N. University Ave, Ann Arbor, MI, 48109
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109
| | - Maria Masotti
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109
| | - Russell E Bornschein
- Department of Chemistry, University of Michigan, 930 N. University Ave, Ann Arbor, MI, 48103
| | - Matthew S Davenport
- Department of Radiology and Department of Urology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109
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Gaur S, Troost JP, Fung CM, Breeden J, Barkmeier D, Shankar PR, Khalatbari S, Davenport MS. Radiologists predict differential resource utilization but not clinical outcome in emergency department patients imaged with ultrasound for right upper quadrant pain. Abdom Radiol (NY) 2024:10.1007/s00261-024-04244-5. [PMID: 38400982 DOI: 10.1007/s00261-024-04244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Radiologists with diverse training, specialization, and habits interpret imaging in the Emergency Department. It is necessary to understand if their variation predicts differential value. The purpose of this study was to determine whether attending radiologist variation predicts major clinical outcomes in adult Emergency Department patients imaged with ultrasound for right upper quadrant pain. METHODS Consecutive ED patients imaged with ultrasound for RUQ pain from 10/8/2016 to 8/10/2022 were included (N = 7097). The primary outcome was prediction of hospital admission by signing attending radiologist. Secondary outcomes included: ED and hospital length of stay (LOS), 30-day mortality, 30-day re-presentation rate, subspecialty consultation, advanced imaging follow up (HIDA, MRI, CT), and intervention (ERCP, drainage or surgery). Sample size was determined a priori (detectable effect size: w = 0.06). Data were adjusted for demographic data, Elixhauser comorbidities, number of ED visits in prior year, clinical data, and system factors (38 covariates). P-values were corrected for multiple comparisons (false discovery rate-adjusted p-values). RESULTS The included ultrasounds were read by 35 radiologists (median exams/radiologist: 145 [74.5-241.5]). Signing radiologist did not predict hospitalization (p = 0.85), abdominopelvic surgery or intervention within 30 days, re-presentation to the Emergency Department within 30 days, or subspecialty consultation. Radiologist did predict difference in Emergency Department length of stay (p < 0.001) although this difference was small and imprecise. HIDA was mentioned variably by radiologists (range 0-19%, p < 0.001), and mention of HIDA in the ultrasound report increased 10-fold the odds of HIDA being performed in the next 72 h (odds ratio 10.4 [8.0-13.4], p < 0.001). CONCLUSION Radiologist variability did not predict meaningful outcome differences for patients with right upper quadrant pain undergoing ultrasound in the Emergency Department, but when radiologists mention HIDA in their reports, it predicts a 10-fold increase in the odds a HIDA is performed. Radiologists are relied on for interpretation that shapes subsequent patient care, and it is important to consider how radiologist variability can influence both outcome and resource utilization.
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Affiliation(s)
- Sonia Gaur
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Christopher M Fung
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joshua Breeden
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Barkmeier
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Prasad R Shankar
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shokoufeh Khalatbari
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Dhir A, Ellimoottil CS, Qi J, Zhu A, Wang RS, Montgomery JS, Salami SS, Wei JT, Shankar PR, Davenport MS, Curci NE, Millet JD, Wu CY, Johnson A, Miller DC, George AK. Intra-practice Urologist-level Variation in Targeted Fusion Biopsy Outcomes. Urology 2023; 177:122-127. [PMID: 37121355 DOI: 10.1016/j.urology.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy. METHODS All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed. RESULTS A total of 1133 fusion biopsies performed by 5 providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5%-46.9%, adjusted P-value = .575). Clinically significant cancer detection rates ranged from 11.1% to 16.7% in PI-RADS 3 (unadjusted P = .838), from 24.6% to 43.4% in PI-RADS 4 (adjusted P = .003), and from 69.4% to 78.8% in PI-RADS 5 (adjusted P = .766) lesions. CONCLUSION There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.
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Affiliation(s)
- Apoorv Dhir
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Chad S Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Alex Zhu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Robert S Wang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Jeffrey S Montgomery
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Simpa S Salami
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - John T Wei
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Prasad R Shankar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Matthew S Davenport
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Nicole E Curci
- Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - John D Millet
- Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Chen-Yu Wu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Anna Johnson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - David C Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Arvin K George
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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Jha N, Thapa B, Pathak SB, Pandey A, Pokhrel S, Shankar PR, Bhandary S, Mudvari A, Dangal G. A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:351-358. [PMID: 37042379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS.
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Affiliation(s)
- N Jha
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - B Thapa
- Department of Emergency Medicine, Kirtipur Hospital, Kirtipur, Nepal
| | - S B Pathak
- Department of Intensive Care Unit and Critical care, Nepal Mediciti Hospital, Sainbu, Bhaisepati, Nepal
| | - A Pandey
- Department of General Surgery, Madhyapur Hospital, Bhaktapur, Nepal
| | - S Pokhrel
- Department of Emergency Medicine, Nidan Hospital, Lalitpur, Pulchowk, Nepal
| | - P R Shankar
- IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia
| | - S Bhandary
- Department of Community Health Sciences and School of Public Health, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - A Mudvari
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | - G Dangal
- Kathmandu Model Hospital, Kathmandu, Nepal
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Shankar PR, Maturen KE. Response to: Letter to the Editor Regarding Survey Research: A Primer for the Academic Radiologist. Acad Radiol 2022; 29 Suppl 5:S127. [PMID: 30316707 DOI: 10.1016/j.acra.2018.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 11/01/2022]
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Sun D, Hadjiiski L, Alva A, Zakharia Y, Joshi M, Chan HP, Garje R, Pomerantz L, Elhag D, Cohan RH, Caoili EM, Kerr WT, Cha KH, Kirova-Nedyalkova G, Davenport MS, Shankar PR, Francis IR, Shampain K, Meyer N, Barkmeier D, Woolen S, Palmbos PL, Weizer AZ, Samala RK, Zhou C, Matuszak M. Computerized Decision Support for Bladder Cancer Treatment Response Assessment in CT Urography: Effect on Diagnostic Accuracy in Multi-Institution Multi-Specialty Study. Tomography 2022; 8:644-656. [PMID: 35314631 PMCID: PMC8938803 DOI: 10.3390/tomography8020054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 11/22/2022] Open
Abstract
This observer study investigates the effect of computerized artificial intelligence (AI)-based decision support system (CDSS-T) on physicians’ diagnostic accuracy in assessing bladder cancer treatment response. The performance of 17 observers was evaluated when assessing bladder cancer treatment response without and with CDSS-T using pre- and post-chemotherapy CTU scans in 123 patients having 157 pre- and post-treatment cancer pairs. The impact of cancer case difficulty, observers’ clinical experience, institution affiliation, specialty, and the assessment times on the observers’ diagnostic performance with and without using CDSS-T were analyzed. It was found that the average performance of the 17 observers was significantly improved (p = 0.002) when aided by the CDSS-T. The cancer case difficulty, institution affiliation, specialty, and the assessment times influenced the observers’ performance without CDSS-T. The AI-based decision support system has the potential to improve the diagnostic accuracy in assessing bladder cancer treatment response and result in more consistent performance among all physicians.
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Affiliation(s)
- Di Sun
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
- Correspondence:
| | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Ajjai Alva
- Department of Internal Medicine-Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA; (A.A.); (P.L.P.)
| | - Yousef Zakharia
- Department of Internal Medicine-Hematology/Oncology, University of Iowa, Iowa, IA 52242, USA; (Y.Z.); (R.G.); (D.E.)
| | - Monika Joshi
- Department of Internal Medicine-Hematology/Oncology, Pennsylvania State University, Hershey, PA 16801, USA; (M.J.); (L.P.)
| | - Heang-Ping Chan
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Rohan Garje
- Department of Internal Medicine-Hematology/Oncology, University of Iowa, Iowa, IA 52242, USA; (Y.Z.); (R.G.); (D.E.)
| | - Lauren Pomerantz
- Department of Internal Medicine-Hematology/Oncology, Pennsylvania State University, Hershey, PA 16801, USA; (M.J.); (L.P.)
| | - Dean Elhag
- Department of Internal Medicine-Hematology/Oncology, University of Iowa, Iowa, IA 52242, USA; (Y.Z.); (R.G.); (D.E.)
| | - Richard H. Cohan
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Elaine M. Caoili
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Wesley T. Kerr
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Kenny H. Cha
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD 20993, USA;
| | | | - Matthew S. Davenport
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Prasad R. Shankar
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Isaac R. Francis
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Kimberly Shampain
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Nathaniel Meyer
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Daniel Barkmeier
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Sean Woolen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Phillip L. Palmbos
- Department of Internal Medicine-Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA; (A.A.); (P.L.P.)
| | - Alon Z. Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Ravi K. Samala
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Chuan Zhou
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (H.-P.C.); (R.H.C.); (E.M.C.); (M.S.D.); (P.R.S.); (I.R.F.); (K.S.); (N.M.); (D.B.); (S.W.); (R.K.S.); (C.Z.)
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA;
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Sayyouh MMH, Sella EC, Shankar PR, Marshall GE, Quint LE, Agarwal PP. Lessons Learned from Peer Learning Conference in Cardiothoracic Radiology. Radiographics 2022; 42:579-593. [PMID: 35148241 DOI: 10.1148/rg.210125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical errors may lead to patient harm and may also have a devastating effect on medical providers, who may suffer from guilt and the personal impact of a given error (second victim experience). While it is important to recognize and remedy errors, it should be done in a way that leads to long-standing practice improvement and focuses on systems-level opportunities rather than in a punitive fashion. Traditional peer review systems are score based and have some undesirable attributes. The authors discuss the differences between traditional peer review systems and peer learning approaches and offer practical suggestions for transitioning to peer learning conferences. Peer learning conferences focus on learning opportunities and embrace errors as an opportunity to learn. The authors also discuss various types and sources of errors relevant to the practice of radiology and how discussions in peer learning conferences can lead to widespread system improvement. In the authors' experience, these strategies have resulted in practice improvement not only at a division level in radiology but in a broader multidisciplinary setting as well. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Mohamed M H Sayyouh
- From the Cardiothoracic Imaging Division, Department of Radiology, University of Michigan, Taubman Center B1-132D, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5302 (M.M.H.S., E.C.S., G.E.M., L.E.Q., P.P.A.); and Abdominal Imaging Division and Michigan Radiology Quality Collaborative, Department of Radiology, University of Michigan, Ann Arbor, Mich (P.R.S.)
| | - Edith C Sella
- From the Cardiothoracic Imaging Division, Department of Radiology, University of Michigan, Taubman Center B1-132D, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5302 (M.M.H.S., E.C.S., G.E.M., L.E.Q., P.P.A.); and Abdominal Imaging Division and Michigan Radiology Quality Collaborative, Department of Radiology, University of Michigan, Ann Arbor, Mich (P.R.S.)
| | - Prasad R Shankar
- From the Cardiothoracic Imaging Division, Department of Radiology, University of Michigan, Taubman Center B1-132D, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5302 (M.M.H.S., E.C.S., G.E.M., L.E.Q., P.P.A.); and Abdominal Imaging Division and Michigan Radiology Quality Collaborative, Department of Radiology, University of Michigan, Ann Arbor, Mich (P.R.S.)
| | - Giselle E Marshall
- From the Cardiothoracic Imaging Division, Department of Radiology, University of Michigan, Taubman Center B1-132D, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5302 (M.M.H.S., E.C.S., G.E.M., L.E.Q., P.P.A.); and Abdominal Imaging Division and Michigan Radiology Quality Collaborative, Department of Radiology, University of Michigan, Ann Arbor, Mich (P.R.S.)
| | - Leslie E Quint
- From the Cardiothoracic Imaging Division, Department of Radiology, University of Michigan, Taubman Center B1-132D, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5302 (M.M.H.S., E.C.S., G.E.M., L.E.Q., P.P.A.); and Abdominal Imaging Division and Michigan Radiology Quality Collaborative, Department of Radiology, University of Michigan, Ann Arbor, Mich (P.R.S.)
| | - Prachi P Agarwal
- From the Cardiothoracic Imaging Division, Department of Radiology, University of Michigan, Taubman Center B1-132D, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5302 (M.M.H.S., E.C.S., G.E.M., L.E.Q., P.P.A.); and Abdominal Imaging Division and Michigan Radiology Quality Collaborative, Department of Radiology, University of Michigan, Ann Arbor, Mich (P.R.S.)
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Roseland ME, Shankar PR, Houck G, Davenport MS. Targeting Missed Care Opportunities Using Modern Communication Methods: A Quality Improvement Initiative to Improve Access to CT and MRI Appointments. Acad Radiol 2022; 29:395-401. [PMID: 33762152 DOI: 10.1016/j.acra.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the impact of automated text and phone call reminder systems on CT (computed tomography) and MRI (magnetic resonance imaging) missed care opportunities. METHODS This was an IRB (institutional review board) exempt prospective interventional quality improvement study. The proportion of missed care opportunities (appointment made, no imaging performed) related to scheduled CT and MRI examinations were evaluated over 2 months (Month 1: reminder phone calls by staff 48-96 hours prior and mailed letter 1-2 weeks prior; Month 2: no manual call or letter, automated text message 24 hours prior, automated phone call 72 hours prior, automated patient portal message 7 days prior). The proportion of missed care opportunities was calculated in aggregate and by modality. Process control p-charts were generated. An a priori power analysis was performed. Chi-squared tests were performed. p-value < 0.017 was considered significant after Bonferroni correction. RESULTS Missed care opportunities occurred for 2.82% (292/10348; 95% CI: 2.51-3.16) of all CT and MRI appointments using traditional communication and 2.44% (262/10719; 95% CI: 2.16-2.75) using automated communication (p = 0.09). Automated messaging did not significantly change the proportion of missed care opportunities for CT (traditional: 2.62% [95% CI: 2.23-3.06] vs. automated: 2.06% [95% CI: 1.70-2.48], p = 0.05) or MRI (traditional: 3.1% [95% CI: 2.60-3.66] vs. automated: 2.83% [95% CI: 2.40-3.30], p = 0.43). Process control p-charts showed dominance of common cause variation. CONCLUSION Automated messaging did not meaningfully change the overall proportion of missed care opportunities compared to traditional human-initiated phone calls. Automated communications may reduce cost and improve efficiency without adversely affecting access to care.
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Lamberg H, Shankar PR, Singh K, Caoili EM, George AK, Hackett C, Johnson A, Davenport MS. Preoperative Prostate MRI Predictors of Urinary Continence Following Radical Prostatectomy. Radiology 2022; 303:99-109. [PMID: 35040671 PMCID: PMC8962824 DOI: 10.1148/radiol.210500] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Urinary continence after radical prostatectomy (RP) is an important determinant of patient quality of life. Anatomic measures at prostate MRI have been previously associated with continence outcomes, but their predictive ability and interrater agreement are unclear in comprehensive clinical models. Purpose To evaluate the predictive ability and interrater agreement of MRI-based anatomic measurements of post-RP continence when combined with clinical multivariable models. Materials and Methods In this retrospective cohort study, continence outcomes were evaluated in men who underwent RP from August 2015 to October 2019. Preoperative MRI-based anatomic measures were obtained retrospectively by four abdominal radiologists. Before participation, these radiologists completed measure-specific training. Logistic regression models were developed with clinical variables alone, MRI variables alone, and combined variables for predicting continence at 3, 6, and 12 months after RP; some patient data were missing at each time point. Interrater agreement of MRI variables was assessed by using intraclass correlation coefficients (ICCs). Results A total of 586 men were included (mean age ± standard deviation: 63 years ± 7). The proportion of patients with incontinence was 0.2% (one of 589) at baseline, 27% (145 of 529) at 3 months, 14% (63 of 465) at 6 months, and 9% (37 of 425) at 12 months. Longer coronal membranous urethra length (MUL) improved the odds of post-RP continence at all time points (odds ratio per 1 mm: 0.86 [95% CI: 0.80, 0.93], P < .001; 0.86 [95% CI: 0.78, 0.95], P = .003; and 0.79 [95% CI: 0.67, 0.91], P = .002, respectively) in models that incorporated both clinical and MRI predictors. No other MRI variables were predictive. Age and baseline urinary function score were the only other predictive clinical variables at every time point. Interrater agreement was moderate (ICC, 0.62) for MUL among readers with measure-specific prostate MRI training and poor among those without the training (ICC, 0.38). Conclusion Preoperative MRI-measured coronal membranous urethra length was an independent predictor of urinary continence after prostatectomy. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Hannah Lamberg
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Prasad R. Shankar
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Karandeep Singh
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Elaine M. Caoili
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Arvin K. George
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Caitlin Hackett
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Anna Johnson
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
| | - Matthew S. Davenport
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H., M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Mich (K.S.)
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Montgomery JR, Brown CS, Zondlak AN, Walsh KW, Kozlowski JE, Pinsky AM, Herriman EA, Sussman J, Lu Y, Stein EB, Shankar PR, Sung RS, Woodside KJ. CT-measured Cortical Volume Ratio Is an Accurate Alternative to Nuclear Medicine Split Scan Ratio Among Living Kidney Donors. Transplantation 2021; 105:2596-2605. [PMID: 33950636 DOI: 10.1097/tp.0000000000003676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 125I-iothalamate clearance and 99mTc diethylenetriamine-pentaacetic acid (99mTc-DTPA) split scan nuclear medicine studies are used among living kidney donor candidates to determine measured glomerular filtration rate (mGFR) and split scan ratio (SSR). The computerized tomography-derived cortical volume ratio (CVR) is a novel measurement of split kidney function and can be combined with predonation estimated GFR (eGFR) or mGFR to predict postdonation kidney function. Whether predonation SSR predicts postdonation kidney function better than predonation CVR and whether predonation mGFR provides additional information beyond predonation eGFR are unknown. METHODS We performed a single-center retrospective analysis of 204 patients who underwent kidney donation between June 2015 and March 2019. The primary outcome was 1-y postdonation eGFR. Model bases were created from a measure of predonation kidney function (mGFR or eGFR) multiplied by the proportion that each nondonated kidney contributed to predonation kidney function (SSR or CVR). Multivariable elastic net regression with 1000 repetitions was used to determine the mean and 95% confidence interval of R2, root mean square error (RMSE), and proportion overprediction ≥15 mL/min/1.73 m2 between models. RESULTS In validation cohorts, eGFR-CVR models performed best (R2, 0.547; RMSE, 9.2 mL/min/1.73 m2, proportion overprediction 3.1%), whereas mGFR-SSR models performed worst (R2, 0.360; RMSE, 10.9 mL/min/1.73 m2, proportion overprediction 7.2%) (P < 0.001 for all comparisons). CONCLUSIONS These findings suggest that predonation CVR may serve as an acceptable alternative to SSR during donor evaluation and furthermore, that a model based on CVR and predonation eGFR may be superior to other methods.
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Affiliation(s)
- John R Montgomery
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Craig S Brown
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | | | - Kevin W Walsh
- Medical School, University of Michigan, Ann Arbor, MI
| | | | | | - Emily A Herriman
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
| | - Jeremy Sussman
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Yee Lu
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Erica B Stein
- Division of Abdominal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Prasad R Shankar
- Division of Abdominal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI
- Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor, MI
| | - Randall S Sung
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
| | - Kenneth J Woodside
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
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Shampain KL, Shankar PR, Troost JP, Galantowicz ML, Pampati RA, Schoenheit TR, Shlensky DA, Barkmeier D, Curci NE, Kaza RK, Khalatbari S, Davenport MS. Interrater Agreement of Bosniak Classification Version 2019 and Version 2005 for Cystic Renal Masses at CT and MRI. Radiology 2021; 302:357-366. [PMID: 34726535 PMCID: PMC8805658 DOI: 10.1148/radiol.2021210853] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background The Bosniak classification system for cystic renal masses was updated in 2019 in part to improve agreement compared with the 2005 version. Purpose To compare and investigate interrater agreement of Bosniak version 2019 and Bosniak version 2005 at CT and MRI. Materials and Methods In this retrospective single-center study, a blinded eight-reader assessment was performed in which 195 renal masses prospectively considered Bosniak IIF-IV (95 at CT, 100 at MRI, from 2006 to 2019 with version 2005) were re-evaluated with Bosniak versions 2019 and 2005. Radiologists (four faculty members, four residents) who were blinded to the initial clinical reading and histopathologic findings assessed all feature components and reported the overall Bosniak class for each system independently. Agreement was assessed with Gwet agreement coefficients. Uni- and multivariable linear regression models were developed to identify predictors of dispersion in the final Bosniak class assignment that could inform system refinement. Results A total of 185 patients were included (mean age, 63 years ± 13 [standard deviation]; 118 men). Overall interrater agreement was similar between Bosniak version 2019 and version 2005 (Gwet agreement coefficient: 0.51 [95% CI: 0.45, 0.57] vs 0.46 [95% CI: 0.42, 0.51]). This was true for experts (0.54 vs 0.49) and novices (0.50 vs 0.47) and at CT (0.56 vs 0.51) and MRI (0.52 vs 0.43). Nine percent of masses prospectively considered cystic using Bosniak version 2005 criteria were considered solid using version 2019 criteria. In general, masses were more commonly classified in lower categories when radiologists used Bosniak version 2019 criteria compared with version 2005 criteria. The sole predictor of dispersion in Bosniak version 2019 class assignment was dispersion in septa or wall quality (ie, smooth vs irregular thickening vs nodule; 72% [MRI] and 60% [CT] overall model variance explained; multivariable P < .001). Conclusion Overall interrater agreement was similar between Bosniak version 2019 and version 2005; disagreements in septa or wall quality were common and strongly predictive of variation in Bosniak class assignment. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Eberhardt in this issue.
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Affiliation(s)
- Kimberly L. Shampain
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Prasad R. Shankar
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Jonathan P. Troost
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Maarten L. Galantowicz
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Rudra A. Pampati
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Taylor R. Schoenheit
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - David A. Shlensky
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Daniel Barkmeier
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Nicole E. Curci
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Ravi K. Kaza
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Shokoufeh Khalatbari
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Matthew S. Davenport
- From the University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
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Hadjiiski LM, Cha KH, Cohan RH, Chan HP, Caoili EM, Davenport MS, Samala RK, Weizer AZ, Alva A, Kirova-Nedyalkova G, Shampain K, Meyer N, Barkmeier D, Woolen SA, Shankar PR, Francis IR, Palmbos PL. Intraobserver Variability in Bladder Cancer Treatment Response Assessment With and Without Computerized Decision Support. ACTA ACUST UNITED AC 2021; 6:194-202. [PMID: 32548296 PMCID: PMC7289252 DOI: 10.18383/j.tom.2020.00013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We evaluated the intraobserver variability of physicians aided by a computerized decision-support system for treatment response assessment (CDSS-T) to identify patients who show complete response to neoadjuvant chemotherapy for bladder cancer, and the effects of the intraobserver variability on physicians' assessment accuracy. A CDSS-T tool was developed that uses a combination of deep learning neural network and radiomic features from computed tomography (CT) scans to detect bladder cancers that have fully responded to neoadjuvant treatment. Pre- and postchemotherapy CT scans of 157 bladder cancers from 123 patients were collected. In a multireader, multicase observer study, physician-observers estimated the likelihood of pathologic T0 disease by viewing paired pre/posttreatment CT scans placed side by side on an in-house-developed graphical user interface. Five abdominal radiologists, 4 diagnostic radiology residents, 2 oncologists, and 1 urologist participated as observers. They first provided an estimate without CDSS-T and then with CDSS-T. A subset of cases was evaluated twice to study the intraobserver variability and its effects on observer consistency. The mean areas under the curves for assessment of pathologic T0 disease were 0.85 for CDSS-T alone, 0.76 for physicians without CDSS-T and improved to 0.80 for physicians with CDSS-T (P = .001) in the original evaluation, and 0.78 for physicians without CDSS-T and improved to 0.81 for physicians with CDSS-T (P = .010) in the repeated evaluation. The intraobserver variability was significantly reduced with CDSS-T (P < .0001). The CDSS-T can significantly reduce physicians' variability and improve their accuracy for identifying complete response of muscle-invasive bladder cancer to neoadjuvant chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ajjai Alva
- Internal Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI
| | | | | | | | | | - Sean A Woolen
- Department of Radiology, University of California, San Francisco, Medical Center, San Francisco, CA
| | | | | | - Phillip L Palmbos
- Internal Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI
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Abstract
Radiologic-pathologic correlation of Prostate Imaging Reporting & Data System (PI-RADS) scores ensures local quality and offers opportunities to improve future iterations of the reporting system. Tracking positive predictive values of lesion-targeted biopsies helps provide generalizable population-level risks associated with each PI-RADS category and can highlight the sources of variation. While this process of formalized pathologic correlation is somewhat new to abdominal radiology, we are fortunate to have a model to follow which was developed by our colleagues in breast imaging. If the success and multi-national adoption of BI-RADS is an indicator, building a scoring system anchored on a histologic reference is an important step to ensuring diagnostic quality and reliability.
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Affiliation(s)
- Matthew S. Davenport
- From the Department of Radiology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
| | - Prasad R. Shankar
- From the Department of Radiology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, Room B2 A209A, Ann Arbor, MI 48109-5030
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Shankar PR, Davenport MS. Risk of Nephrogenic Systemic Fibrosis in Stage 4 and 5 Chronic Kidney Disease Following Group II Gadolinium-based Contrast Agent Administration: Subanalysis by Chronic Kidney Disease Stage. Radiology 2020; 297:447-448. [DOI: 10.1148/radiol.2020201492] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Prasad R. Shankar
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UHB2A209P, Ann Arbor, MI 48109 (P.R.S., M.S.D.); Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor, Mich (P.R.S., M.S.D.); and Department of Urology, Michigan Medicine, Ann Arbor, Mich (M.S.D.)
| | - Matthew S. Davenport
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UHB2A209P, Ann Arbor, MI 48109 (P.R.S., M.S.D.); Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor, Mich (P.R.S., M.S.D.); and Department of Urology, Michigan Medicine, Ann Arbor, Mich (M.S.D.)
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Shankar PR, Maturen KE. Survey Research Reporting in Radiology Publications: A Review of 2017 to 2018. J Am Coll Radiol 2020; 16:1378-1384. [PMID: 31585659 DOI: 10.1016/j.jacr.2019.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess survey research methods and scope based on reporting in the current radiology literature. METHODS A HIPAA-compliant review of the radiology literature was performed. The PubMed/MEDLINE database was queried for survey-based studies published in 2017 and 2018. Citations were screened for inclusion in a multistep process. Inclusion criteria were studies published in 2017 or 2018; publication in one of the four major US radiology journals; and utilization of a survey as a part of study methodology and results. Studies were coded by publication characteristics and survey methodological features. Data were summarized as percentages with 95% confidence intervals (CIs). RESULTS A total of 103 studies were included in the analysis. Studies were published in all the included journals (36.9% Academic Radiology; 21.4% American Journal of Roentgenology; 31.1% Journal of the American College of Radiology; and 10.7% Radiology) and spanned multiple topics of research (28.2% education, 27.2% patient centered, 31.1% physician practice, and 10.7% physician wellness). Surveys were most commonly distributed through an online tool (62.1%; 95% CI: 52-71.5). Most studies did not report methods related to questionnaire design before distribution (57.3%; 95% CI: 47.2-67), and only 66.0% (95% CI: 56.0-75.1) reported survey response rate. CONCLUSION Survey-based research is common in the radiology literature and spans multiple disciplines, populations being surveyed, and journals. Utilizing best-practice survey guidelines may help improve the homogeneity and generalizability of survey-based research in our field.
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Affiliation(s)
- Prasad R Shankar
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan; Michigan Radiology Quality Collaborative, Michigan Medicine, Ann Arbor, Michigan.
| | - Katherine E Maturen
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
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Davenport MS, Shankar PR. Biparametric Prostate MRI Influencing Care Patterns in a Caribbean Population. Radiol Imaging Cancer 2020; 2:e200096. [PMID: 33779668 PMCID: PMC7983729 DOI: 10.1148/rycan.2020200096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Matthew S. Davenport
- From the Departments of Radiology (M.S.D., P.R.S.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109
| | - Prasad R. Shankar
- From the Departments of Radiology (M.S.D., P.R.S.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109
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Woolen SA, Shankar PR, Gagnier JJ, MacEachern MP, Singer L, Davenport MS. Risk of Nephrogenic Systemic Fibrosis in Patients With Stage 4 or 5 Chronic Kidney Disease Receiving a Group II Gadolinium-Based Contrast Agent: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180:223-230. [PMID: 31816007 PMCID: PMC6902198 DOI: 10.1001/jamainternmed.2019.5284] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Risk of nephrogenic systemic fibrosis (NSF) to individual patients with stage 4 or 5 chronic kidney disease (CKD; defined as estimated glomerular filtration rate of <30 mL/min/1.73 m2) who receive a group II gadolinium-based contrast agent (GBCA) is not well understood or summarized in the literature. OBJECTIVE To assess the pooled risk of NSF in patients with stage 4 or 5 CKD receiving a group II GBCA. DATA SOURCES A health sciences informationist searched the Ovid (MEDLINE and MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citation, and Daily and Versions), Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Open Grey databases from inception to January 29, 2019, yielding 2700 citations. STUDY SELECTION Citations were screened for inclusion in a multistep process. Agreement for final cohort inclusion was determined by 2 blinded screeners using Cohen κ. Inclusion criteria consisted of stage 4 or 5 CKD with or without dialysis, administration of an unconfounded American College of Radiology classification group II GBCA (gadobenate dimeglumine, gadobutrol, gadoterate meglumine, or gadoteridol), and incident NSF as an outcome. Conference abstracts, retracted manuscripts, narrative reviews, editorials, case reports, and manuscripts not reporting total group II GBCA administrations were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was performed for all studies by a single investigator, including publication details, study design and time frame, patient characteristics, group II GBCA(s) administered, total exposures for patients with stage 4 or stage 5 CKD, total cases of unconfounded NSF, reason for GBCA administration, follow-up duration, loss to follow-up, basis for NSF screening, and diagnosis. MAIN OUTCOMES AND MEASURES Pooled incidence of NSF and the associated upper bound of a 2-sided 95% CI (risk estimate) for the pooled data and each of the 4 group II GBCAs. RESULTS Sixteen unique studies with 4931 patients were included (κ = 0.68) in this systematic review and meta-analysis. The pooled incidence of NSF was 0 of 4931 (0%; upper bound of 95% CI, 0.07%). The upper bound varied owing to different sample sizes for gadobenate dimeglumine (0 of 3167; upper bound of 95% CI, 0.12%), gadoterate meglumine (0 of 1204; upper bound of 95% CI, 0.31%), gadobutrol (0 of 330; upper bound of 95% CI, 1.11%), and gadoteridol (0 of 230; upper bound of 95% CI, 1.59%). CONCLUSIONS AND RELEVANCE This study's findings suggest that the risk of NSF from group II GBCA administration in stage 4 or 5 CKD is likely less than 0.07%. The potential diagnostic harms of withholding group II GBCA for indicated examinations may outweigh the risk of NSF in this population. TRIAL REGISTRATION PROSPERO identifier: CRD42019123284.
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Affiliation(s)
- Sean A Woolen
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor
| | - Prasad R Shankar
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor.,Department of Epidemiology, University of Michigan, Ann Arbor
| | | | - Lisa Singer
- Dana-Farber Cancer Institute, Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor.,Department of Urology, Michigan Medicine, Ann Arbor
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Cha KH, Hadjiiski LM, Cohan RH, Chan HP, Caoili EM, Davenport MS, Samala RK, Weizer AZ, Alva A, Kirova-Nedyalkova G, Shampain K, Meyer N, Barkmeier D, Woolen S, Shankar PR, Francis IR, Palmbos P. Diagnostic Accuracy of CT for Prediction of Bladder Cancer Treatment Response with and without Computerized Decision Support. Acad Radiol 2019; 26:1137-1145. [PMID: 30424999 DOI: 10.1016/j.acra.2018.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/23/2018] [Accepted: 10/09/2018] [Indexed: 10/27/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate whether a computed tomography (CT)-based computerized decision-support system for muscle-invasive bladder cancer treatment response assessment (CDSS-T) can improve identification of patients who have responded completely to neoadjuvant chemotherapy. MATERIALS AND METHODS Following Institutional Review Board approval, pre-chemotherapy and post-chemotherapy CT scans of 123 subjects with 157 muscle-invasive bladder cancer foci were collected retrospectively. CT data were analyzed with a CDSS-T that uses a combination of deep-learning convolutional neural network and radiomic features to distinguish muscle-invasive bladder cancers that have fully responded to neoadjuvant treatment from those that have not. Leave-one-case-out cross-validation was used to minimize overfitting. Five attending abdominal radiologists, four diagnostic radiology residents, two attending oncologists, and one attending urologist estimated the likelihood of pathologic T0 disease (complete response) by viewing paired pre/post-treatment CT scans placed side-by-side on an internally-developed graphical user interface. The observers provided an estimate without use of CDSS-T and then were permitted to revise their estimate after a CDSS-T-derived likelihood score was displayed. Observer estimates were analyzed with multi-reader, multi-case receiver operating characteristic methodology. The area under the curve (AUC) and the statistical significance of the difference were estimated. RESULTS The mean AUCs for assessment of pathologic T0 disease were 0.80 for CDSS-T alone, 0.74 for physicians not using CDSS-T, and 0.77 for physicians using CDSS-T. The increase in the physicians' performance was statistically significant (P < .05). CONCLUSION CDSS-T improves physician performance for identifying complete response of muscle-invasive bladder cancer to neoadjuvant chemotherapy.
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Davenport MS, Montgomery JS, Kunju LP, Siddiqui J, Shankar PR, Rajendiran T, Shao X, Lee E, Denton B, Barnett C, Piert M. 18F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 1. Improved Risk Stratification for MRI-Guided Transrectal Prostate Biopsies. J Nucl Med 2019; 61:337-343. [PMID: 31420496 DOI: 10.2967/jnumed.119.225789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/24/2019] [Indexed: 01/21/2023] Open
Abstract
A prospective single-arm clinical trial was conducted to determine whether 18F-choline PET/mpMRI can improve the specificity of multiparametric MRI (mpMRI) of the prostate for Gleason ≥ 3+4 prostate cancer. Methods: Before targeted and systematic prostate biopsy, mpMRI and 18F-choline PET/CT were performed on 56 evaluable subjects with 90 Likert score 3-5 mpMRI target lesions, using a 18F-choline target-to-background ratio of greater than 1.58 to indicate a positive 18F-choline result. Prostate biopsies were performed after registration of real-time transrectal ultrasound with T2-weighted MRI. A mixed-effects logistic regression was applied to measure the performance of mpMRI (based on prospective Likert and retrospective Prostate Imaging Reporting and Data System, version 2 [PI-RADS], scores) compared with 18F-choline PET/mpMRI to detect Gleason ≥ 3+4 cancer. Results: The per-lesion accuracy of systematic plus targeted biopsy for mpMRI alone was 67.8% (area under receiver-operating-characteristic curve [AUC], 0.73) for Likert 4-5 and 70.0% (AUC, 0.76) for PI-RADS 3-5. Several PET/MRI models incorporating 18F-choline with mpMRI data were investigated. The most promising model selected all high-risk disease on mpMRI (Likert 5 or PI-RADS 5) plus low- and intermediate-risk disease (Likert 4 or PI-RADS 3-4), with an elevated 18F-choline target-to-background ratio greater than 1.58 as positive for significant cancer. Using this approach, the accuracy on a per-lesion basis significantly improved to 88.9% for Likert (AUC, 0.90; P < 0.001) and 91.1% for PI-RADS (AUC, 0.92; P < 0.001). On a per-patient basis, the accuracy improved to 92.9% for Likert (AUC, 0.93; P < 0.001) and to 91.1% for PI-RADS (AUC, 0.91; P = 0.009). Conclusion: 18F-choline PET/mpMRI improved the identification of Gleason ≥ 3+4 prostate cancer compared with mpMRI, with the principal effect being improved risk stratification of intermediate-risk mpMRI lesions.
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Affiliation(s)
- Matthew S Davenport
- Radiology Department, University of Michigan, Ann Arbor, Michigan.,Urology Department, University of Michigan, Ann Arbor, Michigan
| | | | | | - Javed Siddiqui
- Pathology Department, University of Michigan, Ann Arbor, Michigan
| | - Prasad R Shankar
- Radiology Department, University of Michigan, Ann Arbor, Michigan
| | | | - Xia Shao
- Radiology Department, University of Michigan, Ann Arbor, Michigan
| | - Eunjee Lee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.,Department of Information and Statistics, Chungnam National University, Daejeon, South Korea
| | - Brian Denton
- RTI Health Solutions, Research Triangle Park, North Carolina; and
| | - Christine Barnett
- RTI Health Solutions, Research Triangle Park, North Carolina; and.,Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Morand Piert
- Radiology Department, University of Michigan, Ann Arbor, Michigan
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Moorman SE, Shankar PR, Davenport MS. My First Quality Improvement Project. J Am Coll Radiol 2019; 16:980-982. [DOI: 10.1016/j.jacr.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
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23
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Sapkota B, Rauniyar D, Shankar PR, Gupta GK, Thapa RK. Perception about Medicines among the General Public in the Semi-rural Areas of Nepal. Kathmandu Univ Med J (KUMJ) 2019; 17:93-100. [PMID: 32632054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Patients' perceptions and beliefs about medicine are affected by their culture, tradition, socioeconomic status, peer influence, educational level, advertisements among other factors. Objective To explore the perception about medicines among the general public in different semi-rural areas of Nepal. Method Cross-sectional study was conducted at different locations within Kathmandu valley from July 2015 to December 2016; 385 individuals were approached using simple random sampling but only 260, aged 18 years and above, who were taking medicines for their health problems, completed the interviewer-administered survey. Their perceptions about medicines were studied using a structured questionnaire based on the WHO booklet "How to investigate the use of medicines by consumers" and analysed using SPSS version 22. Association between respondents' age, gender, education level and perception were statistically analysed using χ2 test and/or Fisher's exact test and multivariate analysis of variance. Result Sixty-one respondents (23.5%) were in age group 56-65 years. Patients' perceptions of medicine safety based on colour, shape, name of medicine, method of administration, compatibility, etc. was statistically different among respondents with regard to their level of education (p = 0.022). More individuals with lower education believed that expensive medicines were more effective (p < 0.001). Increased level of education made them more aware of negative consequences of reusing previous prescriptions (p=0.039). Conclusion Problems with knowledge about medicines were noted among lesser educated individuals. Based on findings, policy makers may develop educational strategies to increase awareness about medicines.
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Affiliation(s)
- B Sapkota
- Nobel College, Faculty of Health Sciences, Sinamangal, Kathmandu, Nepal
| | - D Rauniyar
- Patan Academy of Health Sciences, Patan Hospital, Lagankhel, Lalitpur, Nepal
| | | | | | - R K Thapa
- Patan Academy of Health Sciences, Patan Hospital, Lagankhel, Lalitpur, Nepal
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24
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Khan O, Shankar PR, Parikh AD, Cohan RH, Keshavarzi N, Khalatbari S, Saad RJ, Davenport MS. Radiographic stool quantification: an equivalence study of 484 symptomatic and asymptomatic subjects. Abdom Radiol (NY) 2019; 44:821-827. [PMID: 30552438 DOI: 10.1007/s00261-018-1869-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if symptomatic patients referred for radiographic stool quantification have equivalent stool burden to asymptomatic patients. METHOD This was an IRB-approved HIPAA-compliant retrospective equivalence cohort study. An a priori equivalence power calculation was performed. Consecutive abdominal radiographs performed in adult outpatients with bloating, constipation, diarrhea, or abdominal pain to assess "fecal loading" [n = 242 (fecal cohort)] were compared to those performed in asymptomatic adult outpatients to assess "renal stones" [n = 242 (renal cohort)]. Radiographs were randomized and reviewed by two blinded independent abdominal radiologists. Exclusion criteria, designed to avoid unblinding, included urinary tract calculi ≥ 0.5 cm, multiple urinary tract calculi, and ureteral stent(s). Readers scored all radiographs (n = 484) for stool burden using validated Leech criteria [scale: 0 (none) to 15 (extreme diffuse)]. Mean Leech scores and 95% confidence intervals were calculated. Multivariable generalized linear modeling was performed to adjust for baseline medication use, age, and gender. The adjusted parameter estimate was used to test for equivalence in the mean difference between cohorts using Schuirmann's method of two one-sided t-tests. Inter-reader agreement was assessed with intraclass correlation coefficients. RESULTS Overall mean Leech scores for fecal [6.9 (95% CI 6.7, 7.2)] and renal [7.3 (95% CI 7.1, 7.5)] cohorts were equivalent within a margin of 0.75 (adjusted mean difference: - 0.4 [90% CI - 0.7, - 0.04]; p value = 0.02). Inter-reader agreement was good [ICC: 0.62 (95% CI 0.56, 0.68)]. CONCLUSION Radiographic stool quantification produces equivalent results in symptomatic and asymptomatic adults and is of uncertain value.
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25
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Shankar PR, Parikh KR, Heilbrun ME, Sweeney BM, Flake AN, Herbstman EA, Hoffman TJ, Havey R, Kronick S, Davenport MS. Cost Implications of Oral Contrast Administration in the Emergency Department: A Time-Driven Activity-Based Costing Analysis. J Am Coll Radiol 2019; 16:30-38. [DOI: 10.1016/j.jacr.2018.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 06/25/2018] [Accepted: 07/20/2018] [Indexed: 12/29/2022]
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26
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Lewis SB, Srinivasa RN, Shankar PR, Bundy JJ, Gemmete JJ, Chick JFB. Thoracic Duct Embolization-Value Analysis Using a Time-Driven Activity-Based Costing Approach: A Single Institution Experience. Curr Probl Diagn Radiol 2018; 49:42-47. [PMID: 30655113 DOI: 10.1067/j.cpradiol.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To quantify cost drivers for thoracic duct embolization based on time-driven activity-based costing methods. MATERIALS AND METHODS This was an Institutional Review Board-approved (HUM00141114) and Health Insurance Portability and Accountability Act-compliant study performed at a quaternary care institution over a 14-month period. After process maps for thoracic duct embolization were prepared, staff practical capacity rates and consumable equipment costs were analyzed via a time-driven activity-based costing methodology. Sensitivity analyses were performed to identify primary cost drivers. RESULTS Mean procedure duration was 4.29 hours (range: 2.15-7.16 hours). Base case cost, per case, for thoracic duct embolization was $7466.67. Multivariate sensitivity analyses performed with all minimum and maximum values for cost input variables yielded a cost range of $1001.95 (minimum) to $89,503.50 (maximum). Using local salary information and negotiated prices for materials as cost parameters, the true cost per case of thoracic duct embolization at the study institution was $8038.94. Univariate analysis demonstrated that the primary driver of staffing costs was the length of time the attending anesthesiologist was present. The predominant modifiable cost drivers included cyanoacrylate glue volume used (minimum $4467; maximum $12,467), cost of glue utilized (minimum $5217; maximum $10,467), and cost of coils utilized (minimum $7377; maximum $10,917). Univariate analysis predicted that the use of Histoacryl glue in place of TRUFILL cyanoacrylate glue resulted in a cost savings of $2947.50 per case. CONCLUSIONS The base cost per case for thoracic duct embolization was $7466.67. Costs, namely anesthesia staffing costs, cyanoacrylate glue, and coils were large, potentially modifiable drivers of overall cost for thoracic duct embolization.
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Affiliation(s)
- Spencer B Lewis
- Department of Radiology Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Ravi N Srinivasa
- Department of Interventional Radiology, University of California Los Angeles, Los Angeles, CA
| | - Prasad R Shankar
- Department of Radiology Division of Abdominal Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Jacob J Bundy
- Department of Radiology Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
| | - Joseph J Gemmete
- Department of Radiology Division of Vascular and Interventional Radiology, University of Michigan Health Systems, Ann Arbor, MI
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Shankar PR, Barkmeier D, Hadjiiski L, Cohan RH. A pictorial review of bladder cancer nodal metastases. Transl Androl Urol 2018; 7:804-813. [PMID: 30456183 PMCID: PMC6212631 DOI: 10.21037/tau.2018.08.25] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022] Open
Abstract
Lymph node involvement in bladder cancer is common and has prognostic implications. Early and accurate identification of metastatic lymph nodes is, therefore, important in ensuring appropriate patient triage and management. The purpose of this review is to provide a pictorial and educational overview of the staging and imaging appearance of metastatic lymph nodes in bladder cancer. Additionally, a secondary aim of this manuscript is to provide a review of the diagnostic accuracy of common imaging modalities available for detecting metastatic lymph nodes in affected patients.
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Affiliation(s)
| | | | | | - Richard H Cohan
- Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA
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28
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Mendiratta-Lala M, Masch W, Shankar PR, Hartman HE, Davenport MS, Schipper MJ, Maurino C, Cuneo KC, Lawrence TS, Owen D. Magnetic Resonance Imaging Evaluation of Hepatocellular Carcinoma Treated With Stereotactic Body Radiation Therapy: Long Term Imaging Follow-Up. Int J Radiat Oncol Biol Phys 2018; 103:169-179. [PMID: 30213751 DOI: 10.1016/j.ijrobp.2018.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine the natural history of imaging findings seen on magnetic resonance imaging (MRI) of hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT). Although arterial hyperenhancement is a key feature of untreated HCC, our clinical experience suggested that tumors that never progressed could still show hyperenhancement. Therefore, we undertook a systematic study to test the hypothesis that persistent arterial phase hyperenhancement (APHE) after SBRT is an expected finding that does not suggest failure of treatment. METHODS AND MATERIALS One hundred forty-six patients undergoing SBRT for HCC between January 1, 2007, and December 31, 2015, were screened retrospectively using an institutional review board-approved prospectively maintained registry. Inclusion criteria were (1) HCC treated with SBRT, (2) multiphasic MRI ≤3 months before SBRT, (3) up to 1 year of follow-up MRI post-SBRT, and (4) cirrhosis. The exclusion criterion was ≤3 months of locoregional therapy to the liver segment containing the SBRT-treated HCC. Pre- and post-SBRT MRI from up to 3 years were analyzed in consensus by independent pairs of subspecialty-trained radiologists to determine the temporal evolution of major features for HCC and imaging findings in off-target parenchyma. RESULTS Sixty-two patients with 67 HCCs (Organ Procurement and Transplantation Network imaging criteria [OPTN] 5a [n = 26], OPTN 5b [n = 28], OPTN 5x [n = 7]; Liver Imaging Reporting Data System [LI-RAD]-M [n = 4] and LiRADs-4 [n = 2]) were studied. Tumor size either decreased (66% [44 of 67]) or remained unchanged (34% [23 of 67]) within the first 12 months. Post-SBRT APHE was common (58% [39 of 67]). When graded using modified Response Evaluation Criteria in Solid Tumors at 3 to 6 months, 25% (17 of 67) met criteria for complete response and 75% (50 of 67) met criteria for stable disease. CONCLUSIONS SBRT is an effective locoregional treatment option for HCC. Persistent APHE is common and does not necessarily indicate viable neoplasm; thus, standard response assessment such as modified Response Evaluation Criteria should be used with caution, particularly in the early phases after SBRT therapy.
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Affiliation(s)
| | - William Masch
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Prasad R Shankar
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Holly E Hartman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Chris Maurino
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kyle C Cuneo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Pandya A, Caoili EM, Jawad-Makki F, Wasnik AP, Shankar PR, Bude R, Haymart MR, Davenport MS. Limitations of the 2015 ATA Guidelines for Prediction of Thyroid Cancer: A Review of 1947 Consecutive Aspirations. J Clin Endocrinol Metab 2018; 103:3496-3502. [PMID: 29982716 DOI: 10.1210/jc.2018-00792] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/27/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND The 2015 American Thyroid Association (ATA) guidelines have been proposed to aid in the management of thyroid nodules by determining whether fine needle aspiration is indicated. OBJECTIVE To determine whether the ATA guidelines contribute to the overdiagnosis of thyroid cancer. PATIENTS AND METHODS This was a retrospective cohort study of ultrasound-imaged thyroid nodules (n = 1947) consecutively aspirated at a tertiary care center from 1 October 2009 to 22 February 2016. Nodules were retrospectively reviewed, assigned a 2015 ATA morphology, and placed into one of five 2015 ATA categories of risk (ATA-1, <1% risk of malignancy; ATA-2, <3% risk; ATA-3, 5% to 10% risk, ATA-4: 10% to 20% risk; ATA-5, >70% to 90% risk) by a reader who was blinded to cytology. ATA category was compared with cytopathology. The positive predictive value (PPV) of each ATA category was calculated with respect to cancer. Numbers needed to aspirate and Pearson correlations were calculated. Interrater agreement for ATA category across five readers was assessed. RESULTS The PPV for cancer increased by ATA category [category 1 to 5, respectively: 0% (0/14), 2% (4/249), 5% (36/733), 12% (104/850), 28% (28/101)]. The number needed to sample to detect one papillary cancer was 125 (ATA-2), 49 (ATA-3), 13 (ATA-4), and 5 (ATA-5). The overall interrater agreement for ATA score across all five readers was fair (intraclass correlation coefficient 0.460). CONCLUSIONS The 2015 ATA guidelines stratify risk for thyroid cancer; however, the stratification system is overly optimistic regarding cancer detection rates for the higher-risk nodules, and there is only fair interrater agreement.
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Affiliation(s)
- Amit Pandya
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Elaine M Caoili
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Farah Jawad-Makki
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Ashish P Wasnik
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Prasad R Shankar
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Ron Bude
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Megan R Haymart
- Department of Internal Medicine, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Matthew S Davenport
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
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Shankar PR, Curci NE, Davenport MS. Characteristics of PI-RADS 4 lesions within the prostatic peripheral zone: a retrospective diagnostic accuracy study evaluating 170 lesions. Abdom Radiol (NY) 2018; 43:2176-2182. [PMID: 29198006 DOI: 10.1007/s00261-017-1415-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether peripheral zone PI-RADS 4 observations can be further risk-stratified. METHODS This was an IRB-approved HIPAA-compliant retrospective diagnostic accuracy study. Peripheral zone PI-RADS 4 observations prospectively identified at the study institution from 8/1/2015 to 12/31/2016 (n = 170 in 149 mpMRIs) were reviewed independently by two blinded genitourinary radiologists on the basis of (a) PI-RADS v2 shape, (b) pattern of peripheral zone sparing, and (c) rationale for PI-RADS 4 designation. Reference standard was targeted MR-ultrasound fusion biopsy and detection of Gleason 7+ prostate cancer. Positive predictive values (PPVs) were calculated. Predictors were assessed with binary logistic regression. RESULTS PI-RADS 4 lesions with a DWI score of 4 were more likely to represent Gleason 7+ prostate cancer (p = 0.008-0.01; Reader 1 PPV: 53%; Reader 2 PPV: 48%). Pattern of peripheral zone sparing and most lesion shapes were not predictive (p > 0.05); however, oval lesions were predictive for Reader 1 (PPV = 59%, p = 0.03) and lentiform lesions were predictive for Reader 2 (PPV = 74%, p = 0.01). Lesions scored as "not meeting PI-RADS 4 criteria" had significantly lower PPV (p = 0.016-0.003; Reader 1 PPV: 14%, Reader 2 PPV: 16%). DISCUSSION Peripheral zone PI-RADS 4 lesions with a DWI score of 4 are more likely Gleason 7+ cancer than those with a DWI score of 3. Lesions overcalled as PI-RADS 4 have PPV similar to published PI-RADS 3 data. Lesion shape and peripheral zone sparing in general do not predict Gleason 7+ cancer within PI-RADS 4 observations.
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Affiliation(s)
- Prasad R Shankar
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive B1-D530H, Ann Arbor, MI, 48109, USA.
| | - Nicole E Curci
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive B1-D530H, Ann Arbor, MI, 48109, USA
| | - Matthew S Davenport
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive B1-D530H, Ann Arbor, MI, 48109, USA
- Department of Urology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
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Shankar PR, Davenport MS, Woolen SA, Carlos RC, Maturen KE. Survey Research: A Primer for the Academic Radiologist. Acad Radiol 2018; 25:751-756. [PMID: 29555571 DOI: 10.1016/j.acra.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 02/04/2018] [Accepted: 02/08/2018] [Indexed: 11/30/2022]
Abstract
Survey research is appealing to many clinical researchers, including radiologists. Emerging interest in patient preferences and patient-centered outcomes related to imaging likely will stimulate additional use of questionnaires in our field. However, like other quantitative methods, survey-based research requires meticulous planning, execution, and analysis to generate reliable results and support meaningful conclusions. The purpose of this review is to provide a guideline for radiologists embarking on this type of research, with attention to questionnaire design, sampling, survey administration, and analysis.
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Affiliation(s)
- Prasad R Shankar
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109.
| | - Matthew S Davenport
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109
| | - Sean A Woolen
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109
| | - Ruth C Carlos
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109
| | - Katherine E Maturen
- Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109
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Shankar PR, Kaza RK, Al-Hawary MM, Masch WR, Curci NE, Mendiratta-Lala M, Sakala MD, Johnson TD, Davenport MS. Impact of Clinical History on Maximum PI-RADS Version 2 Score: A Six-Reader 120-Case Sham History Retrospective Evaluation. Radiology 2018; 288:158-163. [PMID: 29664338 DOI: 10.1148/radiol.2018172619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To assess the impact of clinical history on the maximum Prostate Imaging Recording and Data System (PI-RADS) version 2 (v2) score assigned to multiparametric magnetic resonance (MR) imaging of the prostate. Materials and Methods This retrospective cohort study included 120 consecutively selected multiparametric prostate MR imaging studies performed between November 1, 2016, and December 31, 2016. Sham clinical data in four domains (digital rectal examination, prostate-specific antigen level, plan for biopsy, prior prostate cancer history) were randomly assigned to each case by using a balanced orthogonal design. Six fellowship-trained abdominal radiologists independently reviewed the sham data, actual patient age, and each examination while they were blinded to interreader scoring, true clinical data, and histologic findings. Readers were told the constant sham histories were true, believed the study to be primarily investigating interrater agreement, and were asked to assign a maximum PI-RADS v2 score to each case. Linear regression was performed to assess the association between clinical variables and maximum PI-RADS v2 score designation. Intraclass correlation coefficients (ICCs) were obtained to compare interreader scoring. Results Clinical information had no significant effect on maximum PI-RADS v2 scoring for any of the six readers (P = .09-.99, 42 reader-variable pairs). Distributions of maximum PI-RADS v2 scores in the research context were similar to the distribution of the scores assigned clinically and had fair-to-excellent pairwise interrater agreement (ICC range: 0.53-0.76). Overall interrater agreement was good (ICC: 0.64; 95% confidence interval: 0.57, 0.71). Conclusion Clinical history does not appear to be a substantial bias in maximum PI-RADS v2 score assignment. This is potentially important for clinical nomograms that plan to incorporate PI-RADS v2 score and clinical data into their algorithms (ie, PI-RADS v2 scoring is not confounded by clinical data).
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Affiliation(s)
- Prasad R. Shankar
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
| | - Ravi K. Kaza
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
| | - Mahmoud M. Al-Hawary
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
| | - William R. Masch
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
| | - Nicole E. Curci
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
| | - Mishal Mendiratta-Lala
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
| | - Michelle D. Sakala
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
| | - Timothy D. Johnson
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
| | - Matthew S. Davenport
- From the Departments of Radiology (P.R.S., R.K.K., M.M.A., W.R.M., N.E.C., M.M., M.D.S., M.S.D.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B1-D530H, Ann Arbor, MI 48109; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich (T.D.J.)
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Curci NE, Lane BR, Shankar PR, Noyes SL, Moriarity AK, Kubat A, Brede C, Montgomery JS, Auffenberg GB, Miller DC, Montie JE, George AK, Davenport MS. Integration and Diagnostic Accuracy of 3T Nonendorectal coil Prostate Magnetic Resonance Imaging in the Context of Active Surveillance. Urology 2018; 116:137-143. [PMID: 29653121 DOI: 10.1016/j.urology.2018.02.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the integration of 3T nonendorectal coil multiparametric prostate magnetic resonance imaging (mpMRI) at 2 high-volume practices that routinely use mpMRI in the setting of active surveillance. MATERIALS AND METHODS This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, and dual-institution retrospective cohort study. Subjects undergoing 3T mpMRI without endorectal coil at either study institution over a 13-month period (August 1, 2015-August 31, 2016) were selected based on predefined criteria: clinical T1/T2 Gleason 6 prostate cancer, prostate-specific antigen <15 ng/mL, ≥40 years old, mpMRI within 2 years of prostate biopsy, and Prostate Imaging Reporting and Data System (PI-RADS) v2 score assigned. Subjects surveilled for Gleason ≥3 + 4 prostate cancer were excluded. The primary outcome was detection of Gleason ≥3 + 4 prostate cancer on magnetic resonance-ultrasound fusion biopsy, standard biopsy, or prostatectomy within 6 months following mpMRI. Positive predictive values (PPVs) were calculated. RESULTS A total of 286 subjects (N = 193 from institution 1, N = 93 from institution 2) met the criteria. Most (87% [90 of 104]) with maximum PI-RADS v2 scores of 1-2 did not receive immediate biopsy or treatment and remained on active surveillance. Incidence and PPVs for PI-RADS v2 scores of ≥3 were the following: PI-RADS 3 (n = 57 [20%], PPV 21% [6 of 29]), PI-RADS 4 (n = 96 [34%], PPV 51% [39 of 77]), and PI-RADS 5 (n = 29 [13%], PPV 71% [20 of 28]). No Gleason ≥4 + 3 prostate cancer was identified for PI-RADS v2 scores of 1-3 (0 of 43 with histology). Following mpMRI and subsequent biopsy, 21% (61 of 286) of subjects were removed from active surveillance and underwent definitive therapy. CONCLUSION The 3T nonendorectal coil mpMRI has been integrated into the care of patients on active surveillance and effectively stratifies risk of Gleason ≥3 + 4 prostate cancer in this population.
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Affiliation(s)
- Nicole E Curci
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
| | - Brian R Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | | | - Sabrina L Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | - Andrew K Moriarity
- Advanced Radiology Services, Spectrum Health Medical Group, Grand Rapids, MI
| | - Anthony Kubat
- Department of Pathology, Spectrum Health Medical Group, Grand Rapids, MI
| | - Chris Brede
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | | | | | | | | | | | - Matthew S Davenport
- Department of Radiology, Michigan Medicine, Ann Arbor, MI; Department of Urology, Michigan Medicine, Ann Arbor, MI; Michigan Radiology Quality Collaborative, Ann Arbor, MI.
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Piert M, Shankar PR, Montgomery J, Kunju LP, Rogers V, Siddiqui J, Rajendiran T, Hearn J, George A, Shao X, Davenport MS. Accuracy of tumor segmentation from multi-parametric prostate MRI and 18F-choline PET/CT for focal prostate cancer therapy applications. EJNMMI Res 2018; 8:23. [PMID: 29589155 PMCID: PMC5869349 DOI: 10.1186/s13550-018-0377-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/15/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The study aims to assess the accuracy of multi-parametric prostate MRI (mpMRI) and 18F-choline PET/CT in tumor segmentation for clinically significant prostate cancer. 18F-choline PET/CT and 3 T mpMRI were performed in 10 prospective subjects prior to prostatectomy. All subjects had a single biopsy-confirmed focus of Gleason ≥ 3+4 cancer. Two radiologists (readers 1 and 2) determined tumor boundaries based on in vivo mpMRI sequences, with clinical and pathologic data available. 18F-choline PET data were co-registered to T2-weighted 3D sequences and a semi-automatic segmentation routine was used to define tumor volumes. Registration of whole-mount surgical pathology to in vivo imaging was conducted utilizing two ex vivo prostate specimen MRIs, followed by gross sectioning of the specimens within a custom-made 3D-printed plastic mold. Overlap and similarity coefficients of manual segmentations (seg1, seg2) and 18F-choline-based segmented lesions (seg3) were compared to the pathologic reference standard. RESULTS All segmentation methods greatly underestimated the true tumor volumes. Human readers (seg1, seg2) and the PET-based segmentation (seg3) underestimated an average of 79, 80, and 58% of the tumor volumes, respectively. Combining segmentation volumes (union of seg1, seg2, seg3 = seg4) decreased the mean underestimated tumor volume to 42% of the true tumor volume. When using the combined segmentation with 5 mm contour expansion, the mean underestimated tumor volume was significantly reduced to 0.03 ± 0.05 mL (2.04 ± 2.84%). Substantial safety margins up to 11-15 mm were needed to include all tumors when the initial segmentation boundaries were drawn by human readers or the semi-automated 18F-choline segmentation tool. Combining MR-based human segmentations with the metabolic information based on 18F-choline PET reduced the necessary safety margin to a maximum of 9 mm to cover all tumors entirely. CONCLUSIONS To improve the outcome of focal therapies for significant prostate cancer, it is imperative to recognize the full extent of the underestimation of tumor volumes by mpMRI. Combining metabolic information from 18F-choline with MRI-based segmentation can improve tumor coverage. However, this approach requires confirmation in further clinical studies.
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Affiliation(s)
- Morand Piert
- Radiology Department, University of Michigan, Ann Arbor, MI USA
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Health System, University Hospital B1G505C, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0028 USA
| | | | | | | | - Virginia Rogers
- Radiology Department, University of Michigan, Ann Arbor, MI USA
| | - Javed Siddiqui
- Pathology Department, University of Michigan, Ann Arbor, MI USA
| | | | - Jason Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI USA
| | - Arvin George
- Urology Department, University of Michigan, Ann Arbor, MI USA
| | - Xia Shao
- Radiology Department, University of Michigan, Ann Arbor, MI USA
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Jha N, Rathore DS, Shankar PR, Bhandary S, Alshakka M, Gyawali S. Knowledge, Attitude and Practice Regarding Pharmacovigilance and Consumer Pharmacovigilance among Consumers at Lalitpur District, Nepal. J Nepal Health Res Counc 2017; 15:31-37. [PMID: 28714489 DOI: 10.3126/jnhrc.v15i1.18011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adverse drug reactions (ADRs) can be a big threat to the health of people in Nepal as a variety of medicines are consumed in the country. Involving consumers in pharmacovigilance can strengthen ADR reporting. The study aims to find out knowledge, attitude and practice regarding pharmacovigilance and consumer pharmacovigilance among consumers at Lalitpur district, Nepal Methods: It was carried out in outpatients visiting in KIST Medical College and Teaching Hospital, Lalitpur, Nepal. Participant's knowledge, attitude and practice were measured by noting their agreement with a set of 21 statements along with multiple choice and open ended questions. RESULTS A total of 157 outpatients were surveyed. The knowledge scores for males (12) was better compared to the females (11), but the scores for attitude and practice were same for both groups. The maximum score for knowledge was 29, attitude was 6 and practice was 10. The overall KAP scores was 45. The total scores for knowledge, attitude and practice for males (24) were better compared to female (22) respondents. Seventy-one patients (68%) who participated in this study favoured establishing a consumer centre for obtaining information about ADRs. CONCLUSIONS Knowledge scores among consumers regarding pharmacovigilance is low and require advocacy and improvement.
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Affiliation(s)
- N Jha
- Department of Clinical Pharmacology, KIST Medical College, Lalitpur, Nepal
| | - D S Rathore
- Department of Pharmacy, NIMS University, Rajasthan, India
| | - P R Shankar
- Department of Pharmacology, American International Medical University, St. Lucia, caribbean
| | - S Bhandary
- Department of Community Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - M Alshakka
- Department of Pharmaceutics and Clinical Pharmacy, Aden University, Yemen
| | - S Gyawali
- Department of Clinical Pharmacology, Manipal College of Medical Sciences, Kaski, Nepal
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Abstract
Objective: Standardized patients (SPs) are widely used in medical and other health professions education. At xxxx SPs have been used for teaching-learning and assessment of basic science medical students since January 2013. The opinion of SPs about their involvement in teaching-learning and assessment of students has been recently studied. The present study had the objective of studying student perception about various aspects of the program.Materials and Methods: The study was conducted towards end of March and beginning of April 2016. Student perception regarding the program was studied by noting their degree of agreement with a set of 25 statements. Free text comments were also obtained. Gender, nationality and semester of study of the respondents was noted. The total score was compared among different subgroups of respondents.Results: Ninety-eight of the 107 students (91.6%) participated. The mean ± SD total score was 92.33 ± 13.68 (maximum possible score being 125). The scores were significantly higher among first semester students compared to other semesters. Students agreed that interacting with SPs will prepare them for interacting with patients, for their licensing exams and improve their clinical skills. Students learn how to interact with persons from a different cultural background. Suggestions for further improvement were also obtained. Conclusions: The response rate was high and students’ perception of the SP program was positive. Our experiences would be of special interest to educators in other medical schools with small and/or new SP programs. Similar feedback could be obtained from other xxx schools with SP programs.Asian Journal of Medical Sciences Vol.7(5) 2016 102-107
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Mishra SK, Jha N, Shankar PR, Dahal PK, Khatiwada B, Sapkota YD. An Assessment of Diabetic Retinopathy and Diabetes Management System in Nepal. J Nepal Health Res Counc 2016; 14:104-110. [PMID: 27885292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Visual damage due to diabetic retinopathy is a major concern which can be reduced through appropriate coordination and cooperation between the diabetes management services and diabetic retinopathy services. The study assessed the existence, availability and accessibility of health care services for diabetes mellitus and diabetic retinopathy in Nepal. METHODS The study was carried out from 1 April to 24 June 2015. The tool for assessment of diabetic retinopathy and diabetes management systems developed by the World Health Organization was used for the assessment of major stakeholders like endocrinologists, ophthalmologists, ophthalmic assistants, nurses involved in diabetes care, patients and human resources from Ministry of Health and Population and international non-governmental organizations dealing with eye care services in Nepal. RESULTS Thirty-seven key stakeholders were selected for the study. Six out of fifteen ophthalmologists were unaware about the prioritization of diabetes as national health concern. The main function of diabetes association included patient education and awareness 18(48.6%), clinician education and awareness 16(43.2%). Thirteen professionals (35.1%) said that the patients were not found to be aware about diabetic patients' organizations. The information to community is provided occasionally and only through national-level media. All forms of diabetes care were funded out-of-pocket by the patients themselves. CONCLUSIONS Coordination should be strengthened for an effective and holistic management of diabetes mellitus making diabetes care and diabetic retinopathy services more accessible. Diabetes mellitus and its complications are becoming a public health threat in Nepal.
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Affiliation(s)
- S K Mishra
- Nepal Netra Jyoti Sangh, Tripureshwor, Kathmandu, Nepal
| | - N Jha
- Department of Clinical Pharmacology, KIST Medical College, Lalitpur, Nepal
| | - P R Shankar
- Department of Pharmacology, Xavier University of School of Medicine, Aruba, Kingdom of Netherlands
| | - P K Dahal
- Department of Community Medicine, KIST Medical College, Lalitpur, Nepal
| | - B Khatiwada
- Nepal Technical Assistance Group, Maitighar, Kathmandu, Nepal
| | - Y D Sapkota
- International Agency for of Prevention of Blindness, India
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Shankar PR. Prescribing Skills for Undergraduate Medical Students: Time to Redress the Neglect? Nepal J Epidemiol 2013. [DOI: 10.3126/nje.v3i3.9186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Challenges in teaching health science students about rational use of medicines include reservations of faculty members about the new learning resources, unfamiliarity with small group teaching, lack of involvement of pharmacologists in teaching therapeutics during the clinical years of training and non-involvement of pharmacists and pharmacologists in patient care activities10. These challenges have to be overcome and a major reorientation and refocusing of pharmacology departments in medical schools towards rational therapeutics may be needed. Modern medical education I feel focuses heavily on diagnosis of disease conditions. Considering the increasing complexity of modern treatment regimens, cost of care and the different stakeholders involved it is time ‘prescribing skills’ receive the attention and resources it richly deserves!DOI: http://dx.doi.org/10.3126/nje.v3i3.9186 Nepal Journal of Epidemiology 2013;3(3): 260-261
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Ansari M, Ibrahim MIM, Shankar PR. Mothers’ Knowledge, Attitude and Practice Regarding Diarrhea and its Management in Morang Nepal: An Interventional Study. TROP J PHARM RES 2013. [DOI: 10.4314/tjpr.v11i5.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Shankar PR, Subish P, Alam K. A research methodology workshop on ‘Social issues in use of medicines’ – cooperation between institutions and participant feedback. J Coll Med Sci-Nepal 2012. [DOI: 10.3126/jcmsn.v8i1.6829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A research methodology workshop on social issues in use of medicines was conducted at Pokhara, Nepal from December 21st to 24th, 2008. The present study was conducted to obtain detailed participant feedback about the workshop and obtain suggestions for improvement. The participants’ knowledge was assessed at the start of the workshop and on the final day by noting their agreement with a set of 40 statements using a modified Likert-type scale. The areas of qualitative research, statistics, research methodology, drug use, pharmacovigilance, journal and general were covered. Certain statements were negative and their scores were reversed. The total score was calculated. The median total scores were compared among various subgroups of respondents. Session evaluation was done at the end of each session. A total of twenty-five participants attended the sessions. The workshop significantly improved the median total scores. Significant improvements were also seen in the subcategories Statistics and Journal. The scores of certain statements were low. The evaluation scores of certain sessions were low. The overall participant opinion about the workshop was positive. Occasional problems with accent of the facilitator and lack of internet access were major problems noted. Some participants felt the workshop was too hectic. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 60-67 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6829
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Shankar PR, Piryani RM. Student feedback on an online group used to support a Medical Humanities module in a Nepalese medical school. J Coll Med Sci-Nepal 2012. [DOI: 10.3126/jcmsn.v6i4.6734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: An online Google group was created to supplement a Medical Humanities module at KISTMedical College. Objectives: The present study was carried out to understand student perceptions about the online group, understand factors preventing its widespread use and obtain suggestions for improvement. Method: The study was carried out among first year undergraduate medical students. They were explained the aims and objectives of the study and invited to participate after obtaining written, informed consent. Student feedback was collected in the form of their responses to a set of 10 questions about the online group. The responses were analyzed and common ones tabulated. Results: Fifty-eight of the 75 students participated. Forty-nine students were aware of the group. Only 10 respondents were group members. The group was regarded as a virtual grouping for sharing ideas about Medical Humanities and could provide knowledge about the subject and act as a backup resource in case students were unable to attend a session. The group was felt to be unsuccessful. Problems of internet access, load shedding and problems of managing time were hindering factors. Better publicity about the group, demonstrating the group during Wednesday’s session and making students utilize the group by submitting assignments through it were suggested. Conclusions: The KISTMC MH group was not successful and steps for improvement must be taken in future sessions. Major reasons hindering use of the group were mentioned. The issue should be further explored as online groups are an important means to support curricular initiates in medical schools. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 79-85 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6734
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Shankar PR, Subish P, Paudel R. Knowledge and perception about the Medical Humanities before and after a national workshop. J Coll Med Sci-Nepal 2012. [DOI: 10.3126/jcmsn.v7i2.6688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Medical Humanities programs are common in medical schools in developed nations. In Nepal modules have been conducted at Manipal College of Medical Sciences (MCOMS), Pokhara and KIST Medical College (KISTMC), Lalitpur. A workshop was conducted on 26th September 2010 to familiarize participants with MH. Faculty members, medical and nursing students and doctors participated. Pre and post test were administered to study knowledge and perception about MH. Differences in scores among different subgroups of participants and before and after the workshop were explored.The workshop used interactive small group learning strategies to introduce participants to different aspects of MH. Group work, group presentations, facilitator presentations, interpretation of paintings, brainstorming sessions, and role-plays were the main learning modalities used. Participants’ knowledge and perception about MH was studied by noting their agreement with a set of 25 statements using a modified Likert-type scale. Median total scores were compared among different subgroups of respondents and before and after the module.Twenty-three of the 26 participants (88.5%) completed the pre and post-test. Thirteen respondents were male and 10 female. Only three respondents (13%) had been previously exposed to MH. The median total score before the workshop was 85 (maximum possible score 125). The score was higher among male respondents. The median total score after the workshop was 98 and was significantly higher compared to that before the workshop.The workshop was effective in increasing knowledge and perception of participants about MH. A follow up workshop to consolidate the initial gains is required and is being planned.Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-2, 72-79DOI: http://dx.doi.org/10.3126/jcmsn.v7i2.6688
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Abstract
BACKGROUND Pharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored. AIMS To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal. METHOD A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability. RESULTS A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs. CONCLUSION Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.
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Affiliation(s)
- N Jha
- Department of Pharmacology, KIST Medical College, Lalitpur, Nepal.
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Abstract
BACKGROUND Pharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored. AIMS To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal. METHOD A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability. RESULTS A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs. CONCLUSION Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.
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Affiliation(s)
- N Jha
- Department of Pharmacology, KIST Medical College, Lalitpur, Nepal.
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Shankar PR. What do reviewers look for in an original research article? JNMA J Nepal Med Assoc 2012; 52:95-101. [PMID: 23478739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
In this article common errors committed by authors especially those, whose first language is not English, while writing an original research articleis described. Avoiding common errors and improving chances of publication has also been covered. This article may resemble instruction to the author. However, tips from reviewer's eyes has been given. The abstract is the section of the paper most commonly read and care should be taken while writing this section. Keywordsare usedto retrieve articles following searches and use of words from the MeSH database is recommended.The introduction describes work already conducted in the particular area and briefly mentions how the manuscript will add to the existing knowledge.The methods section describes how the study was conducted, is written in the past tense and is often the first part of the paper to be written. The results describe what was found in the study and is usually written after the methods section.The discussion compares the study with the literature and helps to put the study findings in context. The conclusions should be based on the results of the study. The references should be written strictly according to the journal format. Language should be simple, active voice should be used and jargon avoided. Avoid directly quoting from reference articles and paraphrase these in your own words to avoid plagiarism.
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Affiliation(s)
- P R Shankar
- Department of Pharmacology, KIST Medical College, Lalitpur, Nepal
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Abstract
There are a number of sources available to prescribers to stay up to date about medicines. Prescribers in rural areas in developing countries however, may not able to access some of them. Interventions to improve prescribing can be educational, managerial, and regulatory or use a mix of strategies. Detailing by the pharmaceutical industry is widespread. Academic detailing (AD) has been classically seen as a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits physicians in their offices to provide evidence-based information. Face-to-face sessions, preferably on an individual basis, clear educational and behavioural objectives, establishing credibility with respect to objectivity, stimulating physician interaction, use of concise graphic educational materials, highlighting key messages, and when possible, providing positive reinforcement of improved practices in follow-up visits can increase success of AD initiatives. AD is common in developed countries and certain examples have been cited in this review. In developing countries the authors have come across reports of AD in Pakistan, Sudan, Argentina and Uruguay, Bihar state in India, Zambia, Cuba, Indonesia and Mexico. AD had a consistent, small but potentially significant impact on prescribing practices. AD has much less resources at its command compared to the efforts by the industry. Steps have to be taken to formally start AD in Nepal and there may be specific hindering factors similar to those in other developing nations.
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Affiliation(s)
- P R Shankar
- Department of Clinical Pharmacology, KIST Medical College, Gwarko, Nepal.
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Shankar PR. Reply to comment on: Factors influencing doctor retention in Nepal and other developing countries. Rural Remote Health 2010; 10:1662. [PMID: 21142400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Shankar PR. Attracting and retaining doctors in rural Nepal. Rural Remote Health 2010; 10:1420. [PMID: 20839900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION In Nepal, a number of private sector medical schools have opened recently; although sufficient numbers of doctors are graduating there continues to be a doctor shortage in rural areas. This article analysed the rural doctor shortage in Nepal and reviewed the international literature for strategies that may be suitable for use in Nepal. METHODS Original research articles, reviews, magazine articles and project reports dealing with Nepal and other developing countries during the period 1995 to 2010 were sourced via Google, Google Scholar and Pubmed. Full text access was obtained via WHO's HINARI database. RESULTS The health workforce in Nepal is unevenly distributed resulting in doctor shortages in rural areas. The recent introduction of mandatory rural service for scholarship students was aimed to reduce the loss of medical graduates to developed nations. High tuition fees in private medical schools and low Government wages prevent recent graduates from taking up rural positions, and those who do face many challenges. Potential corrective strategies include community-based medical education, selecting rural-background medical students, and providing a partial or complete tuition fee waiver for medical students who commit to rural service. Traditional healers and paramedical staff can also be trained for and authorized to provide rural health care. CONCLUSIONS A range of strategies developed elsewhere could be used in Nepal, especially community-oriented medical education that involves rural doctors in training medical students. The reimbursement of tuition fees, assistance with relocation, and provision of opportunities for academic and professional advancement for rural doctors should also be considered. Government investment in improving working conditions in rural Nepal would assist rural communities to attract and retain doctors.
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Affiliation(s)
- P R Shankar
- KIST Medical College, Imadol, Lalitpur, Nepal.
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Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B. Drug utilisation among older inpatients in a teaching hospital in Western Nepal. Singapore Med J 2010; 51:28-34. [PMID: 20200772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The proportion of the elderly population in Nepal, though low, is steadily increasing. Studies on drug utilisation among geriatric patients in Western Nepal, a region with the highest proportion of the elderly in all of Nepal, are lacking. The present study was carried out at the Manipal Teaching Hospital, a 700-bed teaching hospital in Pokhara, Western Nepal. METHODS The study was carried out from June 1, 2005 to May 31, 2006 using case records of discharged patients aged 60 years and older. This was an observational study that utilised a retrospective case notes review methodology. The microorganisms isolated on culture and their antibiotic sensitivity patterns were studied. Drug consumption was measured by the defined daily dose (DDD) per 100 bed-days. The mean cost of the drugs was calculated. The percentage of drugs prescribed by generic name and the percentages of fixed-dose combinations used were noted. The basic demographic information of older inpatients, drug utilisation patterns, drug consumption using DDD, organisms isolated and their antibiotic sensitivity patterns, and the mean cost of the drugs were studied. RESULTS A total of 548 patients were admitted. Hypertension, acute exacerbation of chronic obstructive pulmonary disease and cancer were the most common illnesses among the patients. The mean number of drugs consumed by each patient was 7.73. Escherichia coli and Pseudomonas aeruginosa were the most common microorganisms isolated. Ranitidine, multivitamins, amlodipine, ipratropium and dextrose normal saline were most commonly prescribed. The DDD per 100 bed-days of ranitidine and omeprazole (highest values) was 33.48 and 3.51, respectively. The mean cost of drugs was USD26.6, and antibiotics accounted for around 40 percent of the cost. CONCLUSION The use of a high number of drugs, and of parenteral drugs and intravenous fluids, is a common problem. The prescription of generic drugs is low. Guidelines for the use of drugs in the elderly are required and further studies are needed on this issue.
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Affiliation(s)
- P R Shankar
- Department of Pharmacology, Manipal College of Medical Sciences, PO Box 155, Deep Heights, Pokhara, Nepal.
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Shankar PR, Jha N, Bajracharya O, Piryani RM. Learning to maintain a 'proper' relationship with the pharmaceutical industry. Med Teach 2010; 32:183-184. [PMID: 20196201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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