The value of non-enhanced MRI in the evaluation of patients with suspected idiopathic inflammatory myopathy.

INTRODUCTION/AIMS: The performance of magnetic resonance imaging (MRI) for diagnosing suspected idiopathic inflammatory myopathy (IIM) remains controversial. Furthermore, the role of contrast-enhanced magnetic resonance imaging (CE-MRI) sequences is unclear. The aim of this study was to evaluate the sensitivity and specificity of a non-enhanced magnetic resonance imaging (NE-MRI) protocol compared to a CE-MRI protocol in adult patients with confirmed IIM. METHODS: This study retrospectively enrolled patients with suspected IIM who underwent MRI of the upper thigh between 2008 and 2020. The protocol consisted of a T1-weighted (T1w) sequence, a turbo inversion recovery magnitude (TIRM) sequence and a contrast-enhanced T1-weighted sequence (CE-T1w). After randomly stratifying patients into a group with only the T1w and TIRM sequences available and another group with additional availability of CE-T1w, three blinded readers assessed the presence of IIM based on characteristic imaging features. Confirmation of the diagnosis was determined based on the 2017 ACR/EULAR criteria. RESULTS: Of the 80 patients (mean age 49.0 ± 21.1 years; 42 female, 38 male) included, 54 (67.5%) had a positive diagnosis of IIM. Cumulated sensitivity and specificity for MRI to detect IIM was 87.1% and 83.3% in the NE-MRI group versus 87.0% and 63.0% in the CE-MRI group. The group differences for sensitivity and specificity were non-significant for each of the three readers, respectively (p ≥ .081). DISCUSSION: NE-MRI detects suspected IIM with high diagnostic accuracy and performs equivalently to CE-MRI. Therefore, it may be appropriate to omit the use of contrast agents in MRI scans performed for suspected IIM.

Work expectations, their fulfillment, and exhaustion among radiologists of all career levels: what can be learned from the example of Germany.

OBJECTIVES: To evaluate work expectations of radiologists at different career levels, their fulfillment, prevalence of exhaustion, and exhaustion-associated factors. METHODS: A standardized digital questionnaire was distributed internationally to radiologists of all career levels in the hospital and in ambulatory care via radiological societies and sent manually to 4500 radiologists of the largest German hospitals between December 2020 and April 2021. Statistics were based on age- and gender-adjusted regression analyses of respondents working in Germany (510 out of 594 total respondents). RESULTS: The most frequent expectations were "joy at work" (97%) and a "good working atmosphere" (97%), which were considered fulfilled by at least 78%. The expectation of a "structured residency within the regular time interval" (79%) was more frequently judged fulfilled by senior physicians (83%, odds ratio (OR) 4.31 [95% confidence interval (95% CI) 1.95-9.52]), chief physicians (85%, 6.81 [95% CI 1.91-24.29]), and radiologists outside the hospital (88%, 7.59 [95% CI 2.40-24.03]) than by residents (68%). Exhaustion was most common among residents (physical exhaustion: 38%; emotional exhaustion: 36%), in-hospital specialists (29%; 38%), and senior physicians (30%; 29%). In contrast to paid extra hours, unpaid extra hours were associated with physical exhaustion (5-10 extra hours: OR 2.54 [95% CI 1.54-4.19]). Fewer opportunities to shape the work environment were related to a higher probability of physical (2.03 [95% CI 1.32-3.13]) and emotional (2.15 [95% CI 1.39-3.33]) exhaustion. CONCLUSIONS: While most radiologists enjoy their work, residents wish for more training structure. Ensuring payment of extra hours and employee empowerment may help preventing burnout in high-risk groups. KEY POINTS: • Most important work expectations of radiologists who work in Germany are "joy at work," a "good working atmosphere," "support for further qualification," and a "structured residency within the regular time interval," with the latter containing potential for improvement according to residents. • Physical and emotional exhaustion are common at all career levels except for chief physicians and for radiologists who work outside the hospital in ambulatory care. • Exhaustion as a major burnout criterion is associated with unpaid extra hours and reduced opportunities to shape the work environment.

Gender differences and cooperation in medical authorships - an analysis of the recent ten years in five key medical disciplines.

BACKGROUND: Career prospects in academic medicine are strongly linked to scientific authorship and this marker has been widely used as an indicator of gender equity in academia. However, direct comparisons of medical disciplines regarding their proportion of female physicians (FP) in different countries are missing. This study examines the gender parity and gender cooperation using first authorships (FA) and senior authorships (SA) of scientific publications in five medical disciplines and six different OECD countries over a 10-year time-trend. METHODS: Articles from three high-impact journals in each of the medical discipline radiology, urology, surgery, gynecology, and pediatrics from the years 2007/8 and 2017/18 were retrospectively reviewed. The gender and affiliation location of the FA and SA of original research articles and reviews were assigned and compared with the proportion of in each discipline for the United States of America, Canada, United Kingdom, France, Germany, and Japan. Mantel-Haenszel test and multinomial logistic regression models were used to calculate differences in proportions of women authors and FP and to assess trends and proportions of FA and SA. RESULTS: 30,803 articles were evaluated. Equally, with rising proportions of FP in all disciplines, the number of women authors increased across years. The shares of women FAs were either significantly higher (urology/surgery/gynecology) or balanced (pediatrics/radiology) compared to the proportion of FP. In contrast, the shares of women SA were balanced only in disciplines with a low proportion of FP (urology and surgery) and otherwise reduced. Women same-gender cooperation was as common as men same-gender cooperation and preferred over a women-led mixed gender cooperation in disciplines where this seemed to be practicable due to the high proportions of FP. CONCLUSION: In contrast to FA, a significant disparity persists in SA, particularly in disciplines with a high proportion of FP. The discrepancy between FA and SA may reflect, among others, dropout from an academic career in early or mid-academic levels, for example, due to structural inequality; together with the findings on gender preference in authorship collaborations, this may inform future strategies for promoting equal career advancement for women physicians.

Push-out bond strength of fiber posts to irradiated and non-irradiated intraradicular dentin.

OBJECTIVES: The aim of this study is to evaluate the influence of ionizing radiotherapy on the resin-dentin interface in endodontically treated teeth restored with fiber posts using a dual-cure resin cement performed with the etch-and-rinse (ER) and self-etch (SE) approaches in terms of push-out bond strength (MPa), and to analyze the post/cement/dentin interface using scanning electron microscopy (SEM). MATERIALS AND METHODS: Seventy-six single-rooted human teeth were used and randomly assigned into two main groups (n = 38): one non-irradiated group (NoRad) and one group subjected to a cumulative radiation dose of 60 Gy (Rad). All root canals were instrumented and were further subdivided into two subgroups (n = 19) following the adhesive approach: ER (RadER; NoRadER) and SE (RadSE; NoRadSE) used for fiber post luting with the universal adhesive and dual cure resin cement. Each root was sectioned perpendicularly to its long axis and sections from the middle third of the roots were chosen for SEM analysis and push-out bond strength test. Two-way ANOVA with post hoc Tukey tests and a dummy variable linear regression analysis were used for data analysis. RESULTS: Regardless of the adhesive approach, push-out bond strength in irradiated teeth resulted in significantly lower values than non-irradiated teeth (p = 0.0001). There were no significant differences between the ER and SE approaches in non-irradiated teeth (p = 0.955), whereas the ER approach showed significantly higher bond strengths than the SE approach in irradiated teeth (p = 0.0001). CONCLUSIONS: Ionizing radiotherapy resulted in dentin structure disruption and negatively affected the push-out bond strength of fiber posts to intraradicular dentin. The reduction in bond strength was also more significant with the SE approach than with the ER approach. CLINICAL RELEVANCE: The alterations resulting from root dentin irradiation seem to influence adhesive systems bond strength to dentin, as these changes contribute to lower push-out bond strength in irradiated groups before fiber post luting. Thus, clinicians should prepare patients with a reasonable restorative treatment plan prior to radiotherapy and simultaneously initiate a preventive program during radiotherapy.

Gender trends in authorships and publication impact in Academic Radiology-a 10-year perspective.

OBJECTIVES: To analyze the development of publication numbers of female authors in high-, medium-, and low-impact radiological journals. METHODS: In this bibliometric analysis, gender of the first (FA) and senior author (SA) was assigned to all original research articles and reviews, published in 10 high-, medium-, and low-impact radiological journals in 2007/8 and 2017/18. The adjusted event rate (AER) and adjusted odds ratio (AOR) were calculated using mixed logistic and multinomial logistic regression models to assess and compare female publications according to impact factor, journal, author position, and combination. RESULTS: The proportion of female FA and female SA in N = 6979 (2007/2008) and N = 7383 (2017/2018) articles increased to 29.1% and 16.1% in 2017/2018, respectively. While most female authorships were continuously observed in medium-impact journals, the strongest increase occurred for both female FA (AOR 2.0; p < .0001) and SA (AOR 2.1; p < .0001) in low-impact journals. Female SA published significantly more often in a low- (AOR 1.5) or medium- (AOR 1.8) than in a high-ranking journal. Among the high-ranking journals, female FA published most frequently in European Radiology (32.4%; 95% CI [29.3-35.8]; p < .0001), female SA in Investigative Radiology (15.9%; 95% CI [13.7-18.4]; p < .0001). Male same-sex authorships decreased (AOR 0.9), but remained at least twice as common as all-female or mixed authorships. CONCLUSION: The increase in female authorship is reflected in all impact areas. Female FA and SA increased most in low-ranking journals but are most common in medium-ranking journals. Female SA remain rare, especially in high impact journals. KEY POINTS: • Compared to the proportion of female radiologists worldwide, female senior authors are underrepresented in all impact areas, in particular in high-impact journals. • Among the included high-ranking radiological journals, female first authors and senior authors were strongest represented in European Radiology and Investigative Radiology, while across all impact areas they mostly published in medium-ranking journals. • Female author combinations were more frequent in low- and medium- than in high-ranking journals, whereas male author combinations remained more common than female senior author collaborations in all impact areas.

Evaluation of senior dental students' general attitude towards the use of rubber dam: a survey among two dental schools.

The purpose of this study was to evaluate the general attitude of senior dental students towards rubber dam use, specifically focusing on endodontic practices prior to starting to serve community. Questionnaires were distributed to senior year students of a private school and a state school in Istanbul. Questions were asked about areas where the students used rubber dam, its advantages and difficulties, and whether they agreed or disagreed with some aspects of the rubber dam. The private school students rated isolation whereas those of the state school selected prevention of aspiration which the top advantage rubber dam provides. Students of the state school agreed with the opinion that isolation cannot be achieved without rubber dam and it extended the procedure with a significantly higher ratio compared to the private school. Within the limitations of the present study, it can be concluded that the perceptions of dental students on rubber dam needs to be improved and strategies should be developed so that this valuable adjunct will comprise one of the indispensable elements of dental care.

Comparision of two different preparation protocol of Ni-Ti Rotary PathFile-ProTaper instruments in simulated s-shaped canals.

INTRODUCTION: The aim of this study is to compare the root canal transportation with the PathFile-ProTaper recommended protocol, PathFile-ProTaper modified protocol and stainless steel K-flexofiles. METHODS: Forty-five ISO 15, 0.02 taper S-shaped Endo Training Blocks were divided randomly into three groups of 15 each and prepared as follows: PathFile-Protaper recommended protocol, Pathfile-Protaper modified protocol and manual preparation with K-Flexofiles. The amount of transportation was assessed by scanning the blocks before and after preparation and superimposing the images. The cutting effects of the instruments from the inner and outer aspects of the root canals were measured and statistically analyzed with the One-way Anova test and Tukey HSD test. RESULTS: Manual preparation caused significantly more transportation than both PathFile-Protaper systems. There was no significant difference regarding transportation between the two Pathfile-Protaper protocols. CONCLUSION: The modified Pathfile-Protaper protocol transported the canal similar to the recommended Pathfile-Protaper protocol. It may be suggested that, while working safety remains unchanged, the shaping procedure and consequently working time can be shortened with fewer instruments. The results of this study can help clinicians to reduce the preparation time with the PathFile-ProTaper rotary system while the preparation quality remains the same.

Surface roughness and cyclic fatigue resistance of a novel shaping system: An in-vitro study.

Recently developed Nickel-Titanium (NiTi) instruments with practical changes have resulted in safer instrumentation. In addition, topographical features on the file surface are a contributing factor to clinical durability. Therefore, this study aimed to investigate both the cyclic fatigue resistance and the roughness change of MTwo and Rotate instruments (VDW, Munich, Germany). Each instrument (n = 6/each group) was scanned with an atomic force microscopy prior to and after instrumentation. In addition, cyclic fatigue testing was conducted for each instrument (n = 11/each group) with stainless-steel blocks, including 45°-60°-90° degrees of curvature milled to the instruments' size. The roughness parameters increased for both systems after instrumentation (p<0.05). Both systems presented an increased roughness following instrumentation (p<0.05). The cyclic fatigue resistance was lowest at 90° for both systems (p<0.05), whereas the Rotate files presented a higher resistance than that of the Mtwo files (p<0.05). Compared to the Mtwo files, Rotate files presented better resistance, while the resistance decreased as the curvature increased.

Resolving a sticky situation: A case report of mechanical thrombectomy of Histoacryl emboli in the right atrium and inferior vena cava.

A 68-year-old male with liver cirrhosis presented with dizziness and dyspnea two days after endoscopic Histoacryl occlusion of gastric varicses. Imaging revealed a large endovascular embolization of Histoacryl glue, spanning from porto-caval collaterals via the inferior vena cava to the right atrium, partially occluding right atrial inflow. This case report describes the successful removal of this large net-like mass of Histoacryl glue using thrombectomy devices from the inferior vena cava and the right atrium. Postprocedure imaging showed near-complete clearance with residual fragments in the superior mesenteric vein and small emboli in the pulmonary arteries. The patient was discharged in stable condition. Histoacryl glue can cause severe complications if embolized. This case highlights the potential of advanced thrombectomy devices for managing embolic complications from endovascular treatments.

Evaluation of a prototype metal artifact reduction algorithm for cone beam CT in patients undergoing radioembolization.

Metal artifacts notoriously pose significant challenge in computed tomography (CT), leading to inaccuracies in image formation and interpretation. Artifact reduction tools have been designed to improve cone beam computed tomography (CBCT) image quality by reducing artifacts caused by certain high-density materials. Metal artifact reduction (MAR) tools are specific algorithms that are applied during image reconstruction to minimize or eliminate artifacts degrading CBCT images. The purpose of the study is to evaluate the effect of a MAR algorithm on image quality in CBCT performed for evaluating patients before transarterial radioembolization (TARE). We retrospectively included 40 consecutive patients (aged 65 ± 13 years; 23 males) who underwent 45 CBCT examinations (Allura FD 20, XperCT Roll protocol, Philips Healthcare, Best, The Netherlands) in the setting of evaluation for TARE between January 2017 and December 2018. Artifacts caused by coils, catheters, and surgical clips were scored subjectively by four readers on a 5-point scale (1 = artifacts affecting diagnostic information to 5 = no artifacts) using a side-by-side display of uncorrected and MAR-corrected images. In addition, readers scored tumor visibility and vessel discrimination. MAR-corrected images were assigned higher scores, indicating better image quality. The differences between the measurements with and without MAR were most impressive for coils with a mean improvement of 1.6 points (95%CI [1.5 1.8]) on the 5-point likert scale, followed by catheters 1.4 points (95%CI [1.3 1.5]) and clips 0.7 points (95%CI [0.3 1.1]). Improvements for other artifact sources were consistent but relatively small (below 0.25 points on average). Interrater agreement was good to perfect (Kendall's W coefficient = 0.68-0.95) and was higher for MAR-corrected images, indicating that MAR improves diagnostic accuracy. A metal artifact reduction algorithm can improve diagnostic and interventional accuracy of cone beam CT in patients undergoing radioembolization by reducing artifacts caused by diagnostic catheters and coils, lowering interference of metal artifacts with adjacent major structures, and improving tumor visibility.

Large Language Models for Simplified Interventional Radiology Reports: A Comparative Analysis.

PURPOSE: To quantitatively and qualitatively evaluate and compare the performance of leading large language models (LLMs), including proprietary models (GPT-4, GPT-3.5 Turbo, Claude-3-Opus, and Gemini Ultra) and open-source models (Mistral-7b and Mistral-8×7b), in simplifying 109 interventional radiology reports. METHODS: Qualitative performance was assessed using a five-point Likert scale for accuracy, completeness, clarity, clinical relevance, naturalness, and error rates, including trust-breaking and post-therapy misconduct errors. Quantitative readability was assessed using Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), SMOG Index, and Dale-Chall Readability Score (DCRS). Paired t-tests and Bonferroni-corrected p-values were used for statistical analysis. RESULTS: Qualitative evaluation showed no significant differences between GPT-4 and Claude-3-Opus for any metrics evaluated (all Bonferroni-corrected p-values: p = 1), while they outperformed other assessed models across five qualitative metrics (p < 0.001). GPT-4 had the fewest content and trust-breaking errors, with Claude-3-Opus second. However, all models exhibited some level of trust-breaking and post-therapy misconduct errors, with GPT-4-Turbo and GPT-3.5-Turbo with few-shot prompting showing the lowest error rates, and Mistral-7B and Mistral-8×7B showing the highest. Quantitatively, GPT-4 surpassed Claude-3-Opus in all readability metrics (all p < 0.001), with a median FRE score of 69.01 (IQR: 64.88-73.14) versus 59.74 (IQR: 55.47-64.01) for Claude-3-Opus. GPT-4 also outperformed GPT-3.5-Turbo and Gemini Ultra (both p < 0.001). Inter-rater reliability was strong (κ = 0.77-0.84). CONCLUSIONS: GPT-4 and Claude-3-Opus demonstrated superior performance in generating simplified IR reports, but the presence of errors across all models, including trust-breaking errors, highlights the need for further refinement and validation before clinical implementation. CLINICAL RELEVANCE/APPLICATIONS: With the increasing complexity of interventional radiology (IR) procedures and the growing availability of electronic health records, simplifying IR reports is critical to improving patient understanding and clinical decision-making. This study provides insights into the performance of various LLMs in rewriting IR reports, which can help in selecting the most suitable model for clinical patient-centered applications.

Gender- and personality-specific differences in academic qualifications, research motivation, and attractiveness of leadership positions: a survey among radiologists from Germany. / Gender- und persönlichkeitsspezifische Unterschiede in akademischer Qualifikation, Forschungsmotivation und Attraktivität von Leitungspositionen in der Radiologie: eine deutschlandweite Umfrage.

This study investigated gender- and personality-specific differences in academic qualifications, research motivation, and options to increase the attractiveness of leadership positions in radiology.A validated questionnaire with 66 questions was distributed via the German Roentgen Society and individually sent to 4,500 radiologists in Germany. Participants were asked about their gender. Personality dimensions were assessed using the OCEAN (Big Five) model. Multivariable regression analyses were employed.Of 510 included participants (women 237 (46.5%)), men were four times more likely to have acquired an associated professorship (AP, Habilitation Privatdozent) ((odds ratio (OR) 4.39 (2.22-8.67)). Also, they planned to achieve an AP more frequently (OR 2.87 (1.47-5.61)). The only gender-specific motivator for an AP was the option to become eligible for the position of chief physician (men OR 2.56 (1.07-6.15)). Mentors increased the probability of acquiring an AP (OR 2.07 (1.13-3.80)) or striving for an AP (4.82 (2.39-9.73)). Female mentees were likelier to have female mentors (OR 4.62 (1.68-12.73)). To increase the attractiveness of leadership positions, female radiologists perceived gender balance at the management level (OR 3.32 (2.28-4.82)), top sharing (OR 2.22 (1.48-3.32)), and better work-life balance (OR 2.02 (1.19-3.43)) as more relevant than male radiologists. More pronounced openness (OR 1.62 (1.10-2.38)) and extroversion (OR 1.45 (1.07-1.97)) were positively associated with planning an AP. More pronounced agreeableness (OR 0.67 (0.50-0.91)) was negatively associated.Research motivation is mainly independent of gender. Academic qualification varies with gender and personality dimensions. Mentoring, female role models, top sharing, and better work-family compatibility could motivate women to pursue academic leadership. · Male radiologists are more frequently motivated to pursue an associated professorship by the option of becoming a chief physician.. · Openness and extroversion make pursuing an associated professorship more likely.. · Role models at the management level, top sharing, and flexible work time are more important for female radiologists.. · Molwitz I, Kemper C, Stahlmann K et al. Gender- and personality-specific differences in academic qualifications, research motivation, and attractiveness of leadership positions: a survey among radiologists from Germany. Fortschr Röntgenstr 2024; DOI 10.1055/a-2415-7337.

Evaluating small coronary stents with dual-source photon-counting computed tomography: effect of different scan modes on image quality and performance in a phantom.

PURPOSE: The study aimed to assess the feasibility and image quality of dual-source photon-counting detector computed tomography (PCD-CT) in evaluating small-sized coronary artery stents with respect to different acquisition modes in a phantom model. METHODS: Utilizing a phantom setup mimicking the average patient's water-equivalent diameter, we examined six distinct coronary stents inflated in a silicon tube, with stent sizes ranging from 2.0 to 3.5 mm, applying four different CT acquisition modes of a dual-source PCD-CT scanner: "high-pitch," "sequential," "spiral" (each with collimation of 144 × 0.4 mm and full spectral information), and "ultra-high-resolution (UHR)" (collimation of 120 × 0.2 mm and no spectral information). Image quality and diagnostic confidence were assessed using subjective measures, including a 4-point visual grading scale (4 = excellent; 1 = non-diagnostic) utilized by two independent radiologists, and objective measures, including the full width at half maximum (FWHM). RESULTS: A total of 24 scans were acquired, and all were included in the analysis. Among all CT acquisition modes, the highest image quality was obtained for the UHR mode [median score: 4 (interquartile range (IQR): 3.67-4.00)] (P = 0.0015, with 37.5% rated as "excellent"), followed by the sequential mode [median score: 3.5 (IQR: 2.84-4.00)], P = 0.0326 and the spiral mode [median score: 3.0 (IQR: 2.53-3.47), P > 0.05]. The lowest image quality was observed for the high-pitch mode [median score: 2 (IQR: 1- 3), P = 0.028]. Similarly, diagnostic confidence for evaluating stent patency was highest for UHR and lowest for high-pitch (P < 0.001, respectively). Measurement of stent dimensions was accurate for all acquisition modes, with the UHR mode showing highest robustness (FWHM for sequential: 0.926 ± 0.061 vs. high-pitch: 0.990 ± 0.083 vs. spiral: 0.962 ± 0.085 vs. UHR: 0.941 ± 0.036, P = non-significant, respectively). CONCLUSION: Assessing small-sized coronary stents using PCD-CT technology is feasible. The UHR mode offers superior image quality and diagnostic confidence, while all modes show consistent and accurate measurements. CLINICAL SIGNIFICANCE: These findings highlight the potential of PCD-CT technology, particularly the UHR mode, to enhance non-invasive coronary stent evaluation. Confirmatory research is necessary to influence the guidelines, which recommend cardiac CT only for stents of 3 mm or larger.

Treatment of right hepatic artery stump bleeding after pylorus-preserving pancreaticoduodenectomy by covered stent endoprosthesis placement.

Serious complications after pancreaticoduodenectomy include rupture of pseudoaneurysms arising from pancreatic fistula and pancreatojejunostomy leakage. We report a case of successful endovascular minimally invasive treatment using a covered stent endoprosthesis of a right hepatic artery stump bleeding following pylorus-preserving pancreaticoduodenectomy that was not suitable for coil or glue embolization due to an insufficiently short neck.

Tablets as an Option for Telemedicine-Evaluation of Diagnostic Performance and Efficiency in Intracranial Arterial Aneurysm Detection.

Purpose: To evaluate a commercially available mobile device for the highly specialized task of detection of intracranial arterial aneurysm in telemedicine. Methods: Six radiologists with three different levels of experience retrospectively interpreted 60 computed tomography (CT) angiographies for the presence of intracranial arterial aneurysm, among them 30 cases with confirmed positive findings. Each radiologist reviewed the angiography datasets twice: once on a dedicated medical-grade workstation and on a commercially available mobile consumer-grade tablet with an interval of 3 months. Diagnostic performance, reading efficiency and subjective scorings including diagnostic confidence were analyzed and compared. Results: Diagnostic performance was comparable on both devices regardless of readers' experience, and no significant differences in sensitivity (66-87.5%) and specificity (79.4-87%) were found. Results obtained with tablets and medical workstations were also comparable in terms of subjective assessment across all reader groups. Conclusions: There was no significant difference between tablet and workstation readings of angiography datasets for the presence of intracranial arterial aneurysm. Sensitivity, specificity, efficiency and subjective scorings were similar with the two devices for all three reader groups. While medical workstations are 10 times more expensive, tablets allow higher mobility especially for radiologists on call.

Foreign Healthcare Professionals in Germany: A Questionnaire Survey Evaluating Discrimination Experiences and Equal Treatment at Two Large University Hospitals.

OBJECTIVE: To identify facilitators and barriers and derive concrete measures towards better workplace integration of migrants working in the German healthcare sector. DESIGN: Two-centre cross-sectional quantitative online survey of experiences of discrimination among healthcare professionals with a migration history in two large German university hospitals. PARTICIPANTS: 251 participants fully completed the questionnaires. MAIN OUTCOME MEASURES: Experiences of discrimination and perception of inequality. RESULTS: Fifty-five percent of migrant health workers had had at least some command of German before arriving in Germany. Members of all professional groups surveyed expressed experiences of discrimination related to language, nationality, race/ethnicity, and sex/gender. The proportions of staff with experiences of discrimination by peers differed significantly among occupational roles, with nurses and technologists having the most experiences of discrimination. The perception of inequality was reported more frequently than experiences of discrimination and had a negative impact on workplace satisfaction. Specifically, the compulsion to compete was a frequent feeling stated by participants. CONCLUSION: The mechanisms of discrimination and structural inequality revealed by our survey could inform specific measures, for example at the management level, to increase workplace satisfaction and attract migrant health workers in the long term.

A prospective randomized controlled trial assessing the effect of music on patients' anxiety in venous catheter placement procedures.

The aim of the study was to assess the influence of music on anxiety levels compared to standard patient care in patients undergoing venous catheter placement procedures. This prospective randomized controlled trial included patients undergoing placement procedures for peripherally inserted central venous catheters (PICC), ports and central venous catheters (CVC). Patients were randomly assigned to a music intervention group (MIG) and a control group (CTRL). State and trait anxiety levels were assessed as primary outcome using the state-trait anxiety inventory (STAI) before and after the procedures. Secondary outcomes comprised averaged heart rate for all participants and time of radiological surveillance for port placement procedures exclusively. 72 participants were included into the final analysis (MIG n = 40; CTRL n = 32). All procedures were successful and no major complications were reported. Mean levels for post-interventional anxieties were significantly lower in the MIG compared to the CTRL (34.9 ± 8.9 vs. 44 ± 12.1; p < 0.001). Mean heart rate in the MIG was significantly lower than in the CTRL (76.1 ± 13.7 vs. 93 ± 8.9; p < 0.001). Procedure time for port implantation was significantly longer in the MIG by 3 min 45 s (p = 0.031). Music exposure during central venous catheter placement procedures highly significantly reduces anxiety and stress levels and can be used to improve patients' overall experience in the angio suite.

Short- and long-term evaluation of disease-specific symptoms and quality of life following uterine artery embolization of fibroids.

BACKGROUND: The purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (≤ 7 months) and long-term (> 7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (< 10 cm) and large (≥ 10 cm) tumors based on the diameter of the dominant fibroid. RESULTS: A total of 245 patients were included into the final data analysis. The Kaplan-Meier analysis showed a cumulative clinical success rate of 75.8% after 70 months until the end of follow-up (9.9 years). All questionnaire subscales showed a highly significant clinical improvement from baseline to short- and long-term follow-up (p < 0.001). Patients with small fibroids showed a significantly better response to UAE in multiple subcategories of the questionnaire than patients with fibroids ≥ 10 cm who had a twofold higher probability of re-intervention in the Cox-regression model. CONCLUSIONS: UAE is an effective treatment method for symptomatic fibroids that leads to quick relief of fibroid-related symptoms with marked improvement of quality of life and is associated with a low risk for re-interventions. Patients with small fibroids tend to show a better response to UAE compared to patients with large fibroids. Trial registration Charité institutional review board, EA4/167/20. Registered 27 November 2020-Retrospectively registered. https://ethikkommission.charite.de/.

Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants.

BACKGROUND: There is a need to examine the effects of different types of oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome. METHODS: In a large multicenter approach, computed tomography-derived imaging markers for PHE (absolute PHE, relative PHE (rPHE), edema expansion distance (EED)) were calculated for patients with OAC-ICH and NON-OAC-ICH. Exploratory analysis for non-vitamin-K-antagonist OAC (NOAC) and vitamin-K-antagonists (VKA) was performed. The predictive performance of logistic regression models, employing predictors of poor functional outcome (modified Rankin scale 4-6), was explored. RESULTS: Of 811 retrospectively enrolled patients, 212 (26.14%) had an OAC-ICH. Mean rPHE and mean EED were significantly lower in patients with OAC-ICH compared to NON-OAC-ICH, p-value 0.001 and 0.007; whereas, mean absolute PHE did not differ, p-value 0.091. Mean EED was also significantly lower in NOAC compared to NON-OAC-ICH, p-value 0.05. Absolute PHE was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95%CI 1.002-1.028; p-value 0.027), but not in OAC-ICH (p-value 0.45). CONCLUSION: Quantitative markers of early PHE (rPHE and EED) were lower in patients with OAC-ICH compared to those with NON-OAC-ICH, with significantly lower levels of EED in NOAC compared to NON-OAC-ICH. Increase of early PHE volume did not increase the likelihood of poor outcome in OAC-ICH, but was independently associated with poor outcome in NON-OAC-ICH. The results underline the importance of etiology-specific treatment strategies. Further prospective studies are needed.