Reducing Fluoroscopic Radiation Exposure During Endomyocardial Biopsy in Pediatric Transplant Recipients.

Endomyocardial biopsy (EMB) with fluoroscopy is used for rejection surveillance in pediatric heart transplantation. Lowering frame rate may reduce radiation, but decreases temporal resolution and image quality. We undertook a quality initiative reducing frame rate from 10 frames per second (FPS) to 5 FPS. To assess whether lowering frame rate can reduce radiation exposure without compromising safety, data on EMBs from 9/2009 to 4/2013 without angiography or intervention were reviewed. Effective dose was calculated from dose area product (DAP) and fluoroscopy time. Complications were reviewed. Independent t test compared pre- and post-data and a general linear model were used to control for confounders. Paired t test of most proximate data was used for pts with EMB before and after our change. Eighty-six patients had 543 EMB. After adjusting for weight, attending, and presence of a fellow, the lower FPS group had a 60.3% reduction in DAP (p < 0.0001) and 53.8% drop in effective dose (p < 0.0001). Fluoroscopy time did not differ. Twenty-eight pts had EMBs both before and after the FPS change. Pair-wise analysis of this group demonstrated a 33% reduction in DAP (p < 0.05) and 37% drop in effective dose (p < 0.01), without difference in fluoroscopy time. No patient had an increase in TR > 1 grade by ECHO. There were no deaths or perforations. Lowering the frame rate reduces radiation exposure by >50% without compromising safety. Efforts to further minimize radiation exposure of this vulnerable population should be considered.

Patient perspectives on primary care behavioral health integration in an urban mental health professional shortage area: Benefits, facilitators, and barriers.

INTRODUCTION: While studies have described the benefits of integrating behavioral health (BH) into primary care (PC), few have examined patients' perspectives, especially in large, urban health systems. In 2015, the University of Chicago Medicine launched the Primary Care Behavioral Health Integration Program, located in a mental health professional shortage area. METHOD: In 2021, semistructured interviews were conducted with adult patients who had discussed their depression symptoms with their primary care clinician (PCC). Participants were asked about their experiences of being screened for depression, discussing BH, and being referred to behavioral health clinicians (BHCs). Interviews were analyzed using thematic analysis and constant comparison, and they were conducted until theme saturation was achieved. RESULTS: Fifteen participants were interviewed, the majority of whom were women and African American/Black, with an average age of 52. Participants expressed that PC-BH integration helps patients recognize BH problems and navigate the BH care system, emphasizes the connection between physical and mental health, and eases conversations through familiar setting and established trust. Patients enumerated barriers to integration, including barriers to BH care in the PC setting, barriers to BH conversations with PCCs/BHCs, and barriers to referrals to psychiatry/external therapy. Patients highlighted facilitators of integration, including trust with their PCC, collaboration between PCCs and BHCs, and population-level screening. DISCUSSION: These perspectives affirm the core strength of PC-BH integration: making BH more accessible and destigmatizing, especially for underserved communities. They also emphasize the importance of collaboration between PCCs and BHCs, shared identities, and actively involving patients in program design and quality improvement interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).