Logistics and administration-related stressors among young physicians working in the emergency medicine (EM) department and their perceived job satisfaction in EM department across hospitals of India: a nationwide multicentric digital survey.

OBJECTIVE: Emergency medicine (EM) is a growing specialty in India with the board approving training programme commencing only since 2009. This study aimed to identify the challenges faced by EM department personnel in the country and to obtain valuable insight into the concerns and problems experienced by them. METHODS: This study was a cross-sectional digital survey conducted among EM department personnel in teaching institutions across India. The study involved 170 respondents, who completed an online questionnaire that covered various aspects of their work and identified the challenges they faced. It also captured potential solutions as perceived by the respondents. RESULTS: A total of n=170 participants completed the survey of which N=164 fulfilled the eligibility criteria. The study revealed significant challenges faced by EM personnel in India. Administrative and clerical work consumed a considerable amount of respondents' time. Understaffing (n=144/164; 87.8%), followed by complains about delay due to hospital administrative processes and policies (n=141/164; 85.9%), and delay in interhospital transfers (n=139/164; 84.8%) were the primary concerns spelt out by the respondents. Additionally, respondents experienced interpersonal conflicts, and verbal/physical abuse and inappropriate behaviour from patients and their family members. Potential key solutions suggested were to improve resources including manpower and take steps to prevent violence against EM staff. CONCLUSION: The study's results call for policy-makers and hospital administrators to address the issues faced by EM department staff. Improving EM department operations can improve patient care and staff well-being. Future research should examine challenges in non-teaching institutions and potential solutions.

A rationale for cone beam CT with extended longitudinal field-of-view in image guided adaptive radiotherapy.

PURPOSE: To investigate the efficacy of using cone beam CT with extended longitudinal field-of-view (CBCTeLFOV) for image guided adaptive radiotherapy (IGART). METHODS: The protocol acquires two CBCT scans with a linear translation of treatment couch in the patient plane, allowing a 1 cm penumbral overlap (i.e. cone beam abutment) and fused as a single DICOM set (CBCTeLFOV) using a custom-developed software script (coded in MatLab®) for extended localization. Systemic validation was performed to evaluate the geometric and Hounsfield Units accuracy at the overlapping regions of the CBCTeLFOV using a Catphan®-504 phantom. Two case studies were used to illustrate the CBCTeLFOV-based IGART workflow in terms of dosimetric and clinical perspectives. Segmentation accuracy/association between repeat CT (re-CT) and CBCTeLFOV was evaluated. Moreover, the efficacy of the CBCTeLFOV image data in deformable registration was also described. RESULTS: Slice geometry, spatial resolution, line profiles and HU accuracy in the overlapping regions of the CBCTeLFOV yielded identical results when compared with reference CBCT. In patient studies, the dice-similarity-coefficient evaluation showed a good association (>0.9) between re-CT and CBCTeLFOV. Dosimetric analysis of the CBCTeLFOV-based adaptive re-plans showed excellent agreement with re-CT based re-plans. Moreover, a similar and consistent pattern of results was also observed using deformed image data (initial planning CT deformed to CBCTeLFOV) with extended longitudinal projection and the same frame-of-reference as that of the CBCTeLFOV. CONCLUSION: Utilization of CBCTeLFOV proves to be clinically appropriate and enables accurate prediction of geometric and dosimetric consequences within the planned course of treatment. The ability to compute CBCTeLFOV-based treatment plans equivalent to re-CT promises a potential improvement in IGART practice.

Echo: A Large Display Interactive Visualization of ICU Data for Effective Care HandOffs.

One of the significant challenges of care transitions in Intensive Care Units (ICUs) is the lack of effective support tools for outgoing clinicians to find, filter, organize, and annotate information that can be effectively handed off to the incoming team. We present a large display interactive multivariate visual approach, aimed towards supporting clinicians during the transition of care. We first provide a characterization of the problem domain in terms of data and tasks, based on an observation session at the University of Illinois Hospital, and on interviews with several biomedical researchers and ICU clinicians. Informed by this experience, we design a scalable, interactive visual approach that supports both overview and detail views of ICU patient data, as well as anomaly detection, comparison, and annotation of the data. We demonstrate a large-display implementation of the visualization on an existing anonymized ICU dataset. Feedback from domain experts indicates this approach successfully meets the requirements of effective care transitions.

A prospective, randomized study: Evaluation of the effect of rosuvastatin in patients with chronic obstructive pulmonary disease and pulmonary hypertension.

OBJECTIVES: Statins by their anti-inflammatory and endothelial stabilizing effect can be beneficial in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH). The present study was done to evaluate the effect of rosuvastatin on pulmonary functions and quality of life (QOL) in patients with concomitant COPD and PH. MATERIALS AND METHODS: It was a prospective, randomized, double-blind, placebo-controlled, study conducted in patients with COPD and PH. A total of sixty patients were assigned to receive either rosuvastatin 10 mg or placebo once a day in addition to their conventional treatment for 12 weeks. Routine blood investigations, pulmonary functions, echocardiogram, exercise capacity, and QOL using a questionnaire were assessed at the baseline and after 12 weeks. RESULTS: In patients of rosuvastatin group, there was a statistically significant increase in peak expiratory flow rate (PEFR) (P = 0.04) but no significant change in other pulmonary functions: Forced vital capacity (FVC), forced expiratory volume at 1 s (FVC, FEV1, FEV1/FVC), and echocardiogram parameters. There was a significant increase in 6-min walk test (6-min walk distance) (P = 0.03) at the end of 12 weeks. On comparing with placebo, rosuvastatin showed a significant reduction (P = 0.045) in COPD exacerbations while adverse effects did not differ. CONCLUSION: Statins have a favorable effect on patients with COPD and PH regarding the improvement in PEFR, COPD exacerbations, and exercise capacity. Such effects can be beneficial in these patients and more so in patients with concomitant coronary artery disease or hyperlipidemia where long-term benefits of statins have been established.