Is Call Karma Real? Resident After-Hours On-Call Imaging at the University of Saskatchewan: An Assessment of Call Volumes Including Inter-Resident Variability.

PURPOSE: Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups. METHODS: Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call. RESULTS: During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected. CONCLUSIONS: Annual increases in scan volumes were modest. Although residents' experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.

The miniaturized pediatric continuous-flow device: Preclinical assessment in the chronic sheep model.

BACKGROUND: The Infant Jarvik 2015 is an implantable axial-flow ventricular assist device (VAD) that has undergone the major evolutionary design modifications to improve hemocompatibility. This study was conducted in anticipation of data submission to the US Food and Drug Administration to obtain Investigational Device Exemption approval. METHODS: The VAD was implanted via a left thoracotomy in Barbado sheep (n = 10, 26 (19-34] kg). Anticoagulation was maintained with coumadin, with a target international normalized ratio of greater than the individual sheep's baseline values. The VAD was managed at the highest possible speed as clinically tolerable. Complete necropsy was performed at the end of the study. RESULTS: There were 2 early mortalities: tension pneumothorax (n = 1) and shower emboli of the fragmented myocardium (n = 1). The remaining 8 sheep (2 with 30-day and 6 with 60-day protocols) completed the anticipated study duration in excellent condition, with the 6 completing 60-day sheep showing appropriate weight gain during support. There were no signs of clinically significant hemolysis, with the final plasma-free hemoglobin of 2 (1-17) mg/dL. Necropsy showed old renal infarction in 7 sheep. Although thromboembolism can be the potential etiology, given the mild anticoagulation regimen, other sources of emboli were identified in 2 sheep (graft coating material and fragmented myocardium). Flow study demonstrated favorable increase in flow (up to 3.0 L/min) in proportion to change in pump speed. CONCLUSIONS: This study has demonstrated that the Infant Jarvik 2015 VAD is capable of maintaining its functionality for an extended period of time with minimal hemolysis.

Depression before and after cardiac surgery: do all patients respond the same?

OBJECTIVE: To characterize the prevalence, incidence, and risk factors for depression before and after cardiac surgery. METHODS: Patients awaiting nonemergent surgery (N = 436), completed the Patient Health Questionnaire-9 for depression, as well as the International Physical Activity Questionnaire short version preoperatively (Q1, n = 436) and at hospital discharge (Q2, n = 374). At baseline patients were categorized depression "naïve," "at risk," or "depressed." At each interval patients were identified as "not depressed" (Patient Health Questionnaire-9 score 0-3), "possibly depressed" (score 4-9), or "depressed" (score >9). Multivariate logistic regression analysis identified independent baseline and perioperative variables associated with depression. RESULTS: Depression prevalence at Q1 and Q2 was 23.6% and 37.7%, respectively (P < .001). The incidence of new depression at discharge was 29.2%. Multivariate logistic regression identified independent variables associated with depression: preoperative left ventricular ejection fraction 30% to 49% (Q1: odds ratio [OR], 1.81; 95% confidence interval [CI], 1.02-3.21; P = .042), left ventricular ejection fraction < 30% (Q1: OR, 2.81; 95% CI, 1.13-6.96; P = .026), physical inactivity (Q1: OR, 2.03; 95% CI; 1.26-3.28; P = .002), baseline at-risk group (Q2: OR, 2.16; 95% CI, 1.28-3.67; P = .004), baseline depressed group (Q2: OR, 7.46; 95% CI, 4.06-13.69; P < .0001), hospital length of stay >7 days (Q2: OR, 1.62; 95% CI, 1.03-2.55; P = .039). CONCLUSIONS: Depression is prevalent in one-third of cardiac surgery patients at time of discharge. It is not associated with operative or postoperative risk factors, with the exception of prolonged hospital stay >7 days. Preoperative depression or being at risk for depression, is associated with the highest risk for postoperative depression.