Systematic review: Yellow fever control through environmental management mechanisms.

OBJECTIVE: Recent research on mosquito vector-borne diseases points to the possibility for a re-emergence of yellow fever. This study investigated attempts at utilising environmental methods and their efficacy for the control of yellow fever and its main vector, Aedes aegypti. METHODS: Potentially eligible studies were searched in Cochrane Library (Reviews and Trials), the Global Index Medicus (encompassing thus the African Index Medicus, the Index Medicus for the Eastern Mediterranean Region, the Index Medicus for the South-East Asia Region, the Latin America and the Caribbean Literature on Health Sciences and the Western Pacific Region Index Medicus), Google Scholar, PubMed and Science Direct. RESULTS: Of a total number of 172 eligible studies, 20 met the pre-defined inclusion criteria. Two of them provided quantitative assessment on the efficacy of the described water management and house screening methods with a reduction of cases of 98%, and of a reduction of larvae of 100%, respectively. The remaining 18 studies described or recommended the elimination of breeding sites (through water or waste management, unspecified, or house destruction), the use of screens for houses and the improvement of air circulation without providing any data to evidence control effectiveness. CONCLUSION: This systematic review provides evidence on the historical use and the perceived effectiveness of environmental management methods for combatting yellow fever. However, these methods would benefit from further investigation via controlled trials to provide data for efficacy, costs, acceptability and feasibility.

Recommendations for additional imaging of abdominal imaging examinations: frequency, benefit, and cost.

OBJECTIVES: To investigate the frequency, determinants, clinical implications, and costs of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations. METHODS: This retrospective study included 2225 abdominal imaging examinations from outside institutions that were reinterpreted as part of standard clinical care at a tertiary care center in a one-year time frame. RESULTS: Two hundred forty-six RAIs were present in 231 of 2225 reports (10.4%) of secondary abdominal imaging interpretations. Patient age and experience of the radiologist who performed the secondary interpretation were independently significantly associated with the presence of an RAI (both p = 0.002), with odds ratios of 0.99 per year increase in patient age (95% confidence interval [CI], 0.98-1.00) and 1.06 per year increase in experience of the radiologist (95% CI, 1.02-1.10). If followed, RAIs changed clinical management in 31.2%. Total costs of all 246 RAIs, whether performed or not by the referring physicians, amounted to €71,032.21, thus resulting in €31.92 per secondary abdominal imaging interpretation. Total costs of the 140 RAIs that were actually performed by the referring physicians amounted to €42,683.08, resulting in €19.18 per secondary abdominal imaging interpretation. CONCLUSIONS: The frequency of RAIs in reports of secondary interpretations of abdominal imaging examinations (which appear to be affected by patients' age and radiologists' experience) and associated costs are non-negligible. However, RAIs not infrequently change clinical management. The presented data may be helpful to radiology departments and healthcare policy makers to make well-informed decisions on the value and facilitation of the practice of secondary interpretations. KEY POINTS: • Frequency of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations at a tertiary care center is approximately 10.4%. • RAIs appear to be more frequently issued in younger patients and by more experienced radiologists, and if followed by referring clinicians, change clinical management in about one third of cases. • RAI costs per secondary interpretation in the Dutch Healthcare system are €31.92 (considering all RAIs) or €19.18 (considering only those RAIs that are actually performed).

Unread Second-Opinion Radiology Reports: A Potential Waste of Health Care Resources.

OBJECTIVE. The purpose of this study was to investigate how frequently second-opinion radiology reports are not read by clinicians and to identify reasons why reports are not read. MATERIALS AND METHODS. This retrospective study included 4696 consecutive second-opinion reports of external imaging examinations that were authorized by subspecialty radiologists at a tertiary care institution over a 1-year period. RESULTS. Of 4696 second-opinion reports, 537 were not read by a clinician, corresponding to a frequency of 11.4% (95% CI, 10.6-12.3%). On multivariate logistic regression analysis, five variables were significantly and independently associated with the second-opinion report not being read: inpatient status (odds ratio [OR], 163.26; p < 0.001), sonography as the imaging modality (OR, 5.07; p = 0.014), surgery (OR, 0.18; p < 0.001) or neurology (OR, 2.82; p < 0.001) as the requesting clinician's specialty, and interventional radiology as the subspecialty of the radiologist who authorized the second-opinion report (OR, 3.52; p = 0.047). We found no significant independent associations between the clinician not reading the second-opinion report and patient age, patient sex, or time between submission of the second-opinion request and finalization of the report. CONCLUSION. A considerable proportion of second-opinion reports are not read by clinicians, which represents an appreciable but potentially reversible waste of health care resources. The reasons why clinicians do not read reports need to be investigated in future studies. If subspecialty radiologists and clinicians take the proven determinants into account, the amount of second-opinion readings with limited additional clinical value may be reduced.

Recommendations in Second Opinion Radiology Reports of Abdominal Imaging Examinations: Referring Clinicians' Compliance and Diagnostic Outcome.

OBJECTIVE. The purpose of this study was to investigate how often referring clinicians comply with recommendations in second opinion radiology reports of abdominal imaging examinations, determinants of their compliance, and diagnostic outcome of recommendations. MATERIALS AND METHODS. This retrospective study included 2225 consecutive tertiary center second opinion radiology reports of abdominal imaging examinations performed at outside institutions. RESULTS. Referring clinicians followed 163 of 307 recommendations, corresponding to a frequency of 53.1% (95% CI, 47.5-58.6%). Logistic regression analysis showed no significant association between referring clinicians' compliance and any of the investigated variables, which included patient age, sex, hospitalization status, indication for reinterpretation, strength and clarity of the recommendation, whether the recommendation was made because of perceived insufficient quality of the original imaging examination, and experience of the radiologist who performed the reinterpretation. Of the 275 recommendations that were eligible for a subanalysis on diagnostic outcome, 147 (53.5%) were followed by the referring clinicians and yielded a malignant diagnosis in 30 cases (20.4%). Of the 128 recommendations that were not followed, the advice would have yielded a malignant diagnosis in four cases (3.1%) if it had been followed. The proportions of malignant diagnoses were significantly different between the recommendations that were followed and those that were not (p < 0.001), favoring a higher proportion of the former. CONCLUSION. Recommendations in second opinion reports of abdominal imaging examinations are frequently followed by referring clinicians, but it remains unclear as to which factors influence their compliance. These recommendations lead to a malignant diagnosis in a considerable number of cases.

Point-of-care ultrasonography: Downstream utilization of and diagnostic (dis)agreements with additional cross-sectional imaging.

OBJECTIVES: Point-of-care ultrasonography (POCUS), defined as ultrasonography (US) performed and interpreted by the clinician, is increasingly performed. This study aimed to determine the frequency of and reasons why clinicians of the emergency department request cross-sectional imaging after POCUS and how often radiologists experience diagnostic (dis)agreements. METHODS: This retrospective study included a consecutive series of 503 patients who underwent POCUS at the emergency department of a tertiary care center. RESULTS: Downstream cross-sectional imaging was performed in 77 (15.3%) of 503 POCUS examinations. Reasons for additional cross-sectional imaging were, in order of decreasing frequency: suspicion of pathology that was not assessed with POCUS in 46 cases (59.7%), confirmation of conclusive POCUS findings in 21 cases (27.3%), inconclusive POCUS (i.e. insufficient visualization of the structure of interest to make a diagnosis, despite an attempt of the POCUS operator) in 7 cases (9.6%), a combination of inconclusive POCUS and suspicion of pathology that was not assessed with POCUS in 2 cases (2.6%), and clarification of incidental findings on POCUS in 1 case (1.3%). In the 21 cases that underwent additional cross-sectional imaging to confirm POCUS findings, POCUS agreed with additional cross-sectional imaging in 19 (90.5%) and disagreed in 2 (9.5%) cases. CONCLUSIONS: The use of POCUS appears to not cause any considerable downstream overutilization of cross-sectional imaging. In addition, radiologists experience few diagnostic disagreements when asked to perform second opinion cross-sectional imaging. Future studies with more homogeneous datasets in terms of POCUS operators are required to confirm our results.

The role of urbanisation in the spread of Aedes mosquitoes and the diseases they transmit-A systematic review.

BACKGROUND: This systematic review aims to assess how different urbanisation patterns related to rapid urban growth, unplanned expansion, and human population density affect the establishment and distribution of Aedes aegypti and Aedes albopictus and create favourable conditions for the spread of dengue, chikungunya, and Zika viruses. METHODS AND FINDINGS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using the PubMed, Virtual Health Library, Cochrane, WHO Library Database (WHOLIS), Google Scholar, and and the Institutional Repository for Information Sharing (IRIS) databases. From a total of 523 identified studies, 86 were selected for further analysis, and 29 were finally analysed after applying all inclusion and exclusion criteria. The main explanatory variables used to associate urbanisation with epidemiological/entomological outcomes were the following: human population density, urban growth, artificial geographical space, urban construction, and urban density. Associated with the lack of a global definition of urbanisation, several studies provided their own definitions, which represents one of the study's limitations. Results were based on 8 ecological studies/models, 8 entomological surveillance studies, 7 epidemiological surveillance studies, and 6 studies consisting of spatial and predictive models. According to their focus, studies were categorised into 2 main subgroups, namely "Aedes ecology" and "transmission dynamics." There was a consistent association between urbanisation and the distribution and density of Aedes mosquitoes in 14 of the studies and a strong relationship between vector abundance and disease transmission in 18 studies. Human population density of more than 1,000 inhabitants per square kilometer was associated with increased levels of arboviral diseases in 15 of the studies. CONCLUSIONS: The use of different methods in the included studies highlights the interplay of multiple factors linking urbanisation with ecological, entomological, and epidemiological parameters and the need to consider a variety of these factors for designing effective public health approaches.