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PURPOSE: To assess the effectiveness of an online, case-based interactive course in emergency neuroradiology to prepare radiology residents for night call in neuroradiology. METHODS: A total of 15 residents participated in a pretest assessment of preparedness for neuroradiology call. After completing a 6-week interactive course incorporating case review, didactic lectures, quiz feedback, and references for further review, the same residents were quizzed on cognitive questions and feelings of readiness to enter the on-call pool for neuroradiology. RESULTS: Knowledge and confidence both significantly increased due to the course. Knowledge-wise, the scores for precourse quiz to postcourse quiz went from 18.4%-72.2% (53.8% increase) in Brain Imaging and went from 22.3%-77.1% (54.8% increase) in Head, Neck, and Spine (P < 0.001 for both). Confidence-wise, residents demonstrated statistically significant increases in all 6 confidence measures. Prior to the course, 29% were not confident, 71% were fairly confident, and 0% were confident/very confident. After the course, 0% were not confident, 43% were fairly confident, and 57% were confident/very confident. Belief in the statement "I can provide high quality Neuroimaging services in the emergency care setting" increased from a confidence score of 1.29-2.57 after training (P = 0.004). Nearly all residents completing their first emergency call reported that they felt more confident reading neuroradiology studies during their call as a direct result of the course. CONCLUSIONS: Completing the multi-pronged interactive, case-based online emergency neuroradiology course led to improved funds of knowledge and feelings of confidence and impacted imaging approach in residents taking neuroradiology call.
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Objective To evaluate the difference in hospitalization outcomes, including morbidity and mortality among patients admitted for Pneumocystis pneumonia (PCP) with human immunodeficiency virus (HIV) and non-HIV condition. Methods A case-control study was done using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) data. We identified PCP and HIV as the primary and secondary diagnosis using ICD-9--CM diagnosis codes. We used the multinomial logistic regression model to generate odds ratios (OR). Results A total number of 1250 PCP patients were enrolled in this retrospective analysis. PCP patients with HIV had eight times higher odds of non-elective admission based on emergency condition (OR = 7.873, P < .001) compared to non-HIV patients. PCP patients with HIV had eight times higher odds of longer hospitalization of more than eight days (OR = 8.687, P < .001) compared to non-HIV patients. HIV patients with PCP had five times higher odds of severe morbidity or extreme loss of body function (OR = 5.277, P < .001). PCP patients with HIV had 22 times higher likelihood of in-hospital mortality (OR = 21.845, P < .001) compared to non-HIV patients. Conclusion PCP patients with HIV have a higher risk of severe morbidity and in-hospital mortality as compared to non-HIV patients. More attention needs to be paid to the elderly population that is at a higher risk of PCP with HIV. We need additional research and studies to direct the development of clinical care models for aiming early diagnosis and treatment of HIV in PCP patients.
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Objective This study aimed to determine the differences in hospitalization outcomes among patients admitted for congestive cardiac failure (CCF) with underlying subclinical hypothyroidism (SCH). Methods This retrospective case-control study used data from the nationwide inpatient sample (NIS) for the years 2012-2014. We identified cases with CCF as the primary diagnosis and SCH as the secondary diagnosis using validated ICD-9-CM codes and controls with CCF only. The differences in hospitalization outcomes and hospital characteristics were quantified using the multinomial logistic regression model (adjusted odds ratio (aOR)). Results A total of 143,735 CCF patients were enrolled in this study, and 73,440 cases had IH. About 31.8% of SCH patients were hospitalized for more than four days (median) compared to 44.7% patients without SCH (P < .001). The median hospitalization charges per admission for CCF was $20,312. CCF patients with SCH had lower odds of longer hospitalization (aOR = .709, 95% CI .660-.762, P < .001) and higher hospitalization charges (aOR = .783, 95% CI .728-.841, P < .001) compared to CCF patients without SCH. CCF patients with SCH had two times higher odds of minor morbidity (aOR = 2.276; 95% CI 2.105-2.462; P < .001) but lower odds of major morbidity (aOR = .783; 95% CI .728-.841; P < .001). Inpatient mortality with SCH patients (2%) compared to 3.6% patients without SCH (P < .001). CCF patients with SCH had lower odds of in-hospital mortality (aOR = .547; 95% CI .496-.604; P < .001). CCF patients with SCH had higher odds of being seen in rural non-teaching hospitals (aOR = 1.696; 95% CI 1.572-1.831; P < .001). Also, CCF patients with SCH had the highest likelihood of presence in the western region of the United States (aOR = 149.924; 95% CI 110.497-203.419; P < .001) followed by the southern region (aOR = 31.431; 95% CI 26.066-37.900; P < .001). Conclusions Among CCF with SCH patients during hospitalization, we observed a variation in hospitalization outcomes, including inpatient length of stay and cost, morbidity, and in-hospital mortality. We found no significant increase in mortality and major morbidity in CCF patients with SCH. There were differences in the hospital characteristics between CCF patients with and without SCH. Thus, hospital bed size, location, and teaching status act as predictors for a co-diagnosis of SCH in CCF. Further research is needed to guide the development of clinical care models for targeting early diagnosis and treatment to determine whether thyroid hormone replacement would be beneficial for CCF patients with SCH and improve quality of care in these patients.
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Objective This study determines trends in demographics and hospitalization outcomes among patients admitted for systemic sclerosis (SScl) and evaluates the differences between comorbidities. Methods The study used data from the Nationwide Inpatient Sample (NIS) for the years 2010-2014. We identified SScl as the primary diagnosis and the associated medical and psychiatric comorbidities using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The differences in comorbidities and in-hospital mortality were quantified using multinomial logistic regression (odds ratio (OR)). Results Inpatient admissions for SScl decreased over the period 2010-2014 by 15.9% (p < 0.001). There was an increasing trend in the 61-80 years age group as they had a 29% increase in admissions and a higher risk of in-hospital mortality (OR = 2.113; p = 0.020). The differences between races showed weaker linear trends, with Caucasians (57.5%) showing an increasing trend, and African Americans (24.3%) and Hispanics (11.8%) having a decreasing trend (p < 0.001). However, Hispanics had the highest risk of mortality (OR = 1.295; p = 0.001) during hospitalization. In-hospital mortality had a linear decreasing trend, with a 10.3% decrease in deaths in 2010, and a 9.1% decrease in 2014 (p < 0.001). Hypertension (47.3%), pulmonary circulation disorders (40.1%), pulmonary fibrosis (29.7%), and congestive heart failure (24.4%) constituted the majority of comorbidities. Comorbid diabetes increased the risk of in-hospital mortality in SScl patients by four times (OR = 3.914; p = 0.003). Esophageal reflux disorder was present in only 6.7% of SScl patients, but it increased the risk of in-hospital mortality (OR = 2.643: p < 0.001). Among psychiatric comorbidities, depression (OR = 1.526; p = 0.001) and psychosis (OR = 1.743; p = 0.039) both increased the risk of in-hospital mortality. Conclusion We observed the various comorbidities that were associated with substantial and significant differences in the risk of in-hospital mortality. We assert that these findings indicate that comorbid conditions are influential factors that must be considered in models of health-related quality of life (HRQOL) in SScl. More attention needs to be paid to the elderly population at risk of having a higher risk of inpatient death. Further research to guide the development of clinical care models for targeting early diagnosis and treatment of comorbidities in SScl is necessary to reduce both mortality and morbidity, as well as improve the quality of care for these patients.