Reading room assistants to reduce workload and interruptions of radiology residents during on-call hours: Initial evaluation.

PURPOSE: To determine how much timesaving and reduction of interruptions reading room assistants can provide by taking over non-image interpretation tasks (NITs) from radiology residents during on-call hours. METHODS: Reading room assistants are medical students who were trained to take over NITs from radiology residents (e.g. answering telephone calls, administrative tasks and logistics) to reduce residents' workload during on-call hours. Reading room assistants' and residents' activities were tracked during 6 weekend dayshifts in a tertiary care academic center (with more than 2.5 million inhabitants in its catchment area) between 10 a.m. and 5p.m. (7-hour shift, 420 min), and time spent on each activity was recorded. RESULTS: Reading room assistants spent the most time on the following timesaving activities for residents: answering incoming (41 min, 19%) and outgoing telephone calls (35 min, 16%), ultrasound machine related activities (19 min, 9%) and paramedical assistance such as supporting residents during ultrasound guided procedures and with patients (17 min, 8%). Reading room assistants saved 132 min of residents' time by taking over NITs while also spending circa 31 min consulting the resident, resulting in a net timesaving of 101 min (24%) during a 7-hour shift. The reading room assistants also prevented residents from being interrupted, at a mean of 18 times during the 7-hour shift. CONCLUSION: This study shows that the implementation of reading room assistants to radiology on-call hours could provide a timesaving for residents and also reduce the number of times residents are being interrupted during their work.

Machine learning-based approach reveals essential features for simplified TSPO PET quantification in ischemic stroke patients.

INTRODUCTION: Neuroinflammation evaluation after acute ischemic stroke is a promising option for selecting an appropriate post-stroke treatment strategy. To assess neuroinflammation in vivo, translocator protein PET (TSPO PET) can be used. However, the gold standard TSPO PET quantification method includes a 90 min scan and continuous arterial blood sampling, which is challenging to perform on a routine basis. In this work, we determine what information is required for a simplified quantification approach using a machine learning algorithm. MATERIALS AND METHODS: We analyzed data from 18 patients with ischemic stroke who received 0-90 min [18F]GE-180 PET as well as T1-weigted (T1w), FLAIR, and arterial spin labeling (ASL) MRI scans. During PET scans, five manual venous blood samples at 5, 15, 30, 60, and 85 min post injection (p.i.) were drawn, and plasma activity concentration was measured. Total distribution volume (VT) was calculated using Logan plot with the full dynamic PET and an image-derived input function (IDIF) from the carotid arteries. IDIF was scaled by a calibration factor derived from all the measured plasma activity concentrations. The calculated VT values were used for training a random forest regressor. As input features for the model, we used three late PET frames (60-70, 70-80, and 80-90 min p.i.), the ASL image reflecting perfusion, the voxel coordinates, the lesion mask, and the five plasma activity concentrations. The algorithm was validated with the leave-one-out approach. To estimate the impact of the individual features on the algorithm's performance, we used Shapley Additive Explanations (SHAP). Having determined that the three late PET frames and the plasma activity concentrations were the most important features, we tested a simplified quantification approach consisting of dividing a late PET frame by a plasma activity concentration. All the combinations of frames/samples were compared by means of concordance correlation coefficient and Bland-Altman plots. RESULTS: When using all the input features, the algorithm predicted VT values with high accuracy (87.8 ±â€¯8.3%) for both lesion and non-lesion voxels. The SHAP values demonstrated high impact of the late PET frames (60-70, 70-80, and 80-90 min p.i.) and plasma activity concentrations on the VT prediction, while the influence of the ASL-derived perfusion, voxel coordinates, and the lesion mask was low. Among all the combinations of the late PET frames and plasma activity concentrations, the 70-80 min p.i. frame divided by the 30 min p.i. plasma sample produced the closest VT estimate in the ischemic lesion. CONCLUSION: Reliable TSPO PET quantification is achievable by using a single late PET frame divided by a late blood sample activity concentration.

CADASIL Affects Multiple Aspects of Cerebral Small Vessel Function on 7T-MRI.

OBJECTIVE: Cerebral small vessel diseases (cSVDs) are a major cause of stroke and dementia. We used cutting-edge 7T-MRI techniques in patients with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), to establish which aspects of cerebral small vessel function are affected by this monogenic form of cSVD. METHODS: We recruited 23 CADASIL patients (age 51.1 ± 10.1 years, 52% women) and 13 age- and sex-matched controls (46.1 ± 12.6, 46% women). Small vessel function measures included: basal ganglia and centrum semiovale perforating artery blood flow velocity and pulsatility, vascular reactivity to a visual stimulus in the occipital cortex and reactivity to hypercapnia in the cortex, subcortical gray matter, white matter, and white matter hyperintensities. RESULTS: Compared with controls, CADASIL patients showed lower blood flow velocity and higher pulsatility index within perforating arteries of the centrum semiovale (mean difference - 0.09 cm/s, p = 0.03 and 0.20, p = 0.009) and basal ganglia (mean difference - 0.98 cm/s, p = 0.003 and 0.17, p = 0.06). Small vessel reactivity to a short visual stimulus was decreased (blood-oxygen-level dependent [BOLD] mean difference -0.21%, p = 0.04) in patients, while reactivity to hypercapnia was preserved in the cortex, subcortical gray matter, and normal appearing white matter. Among patients, reactivity to hypercapnia was decreased in white matter hyperintensities compared to normal appearing white matter (BOLD mean difference -0.29%, p = 0.02). INTERPRETATION: Multiple aspects of cerebral small vessel function on 7T-MRI were abnormal in CADASIL patients, indicative of increased arteriolar stiffness and regional abnormalities in reactivity, locally also in relation to white matter injury. These observations provide novel markers of cSVD for mechanistic and intervention studies. ANN NEUROL 2023;93:29-39.

The interdependence of family functioning and problematic internet use in a representative quota sample of adolescents.

Few studies have been carried out investigating the interdependence of family structures or interactions and excessive adolescent Internet use. In this study, we surveyed a representative German quota sample of 1,744 adolescents aged between 14 and 17 years with standardized questionnaires. Adolescents assessed their perceived own functioning in the family with the Self-Rating Scale (FB-S) of the German version of the Family Assessment Measure III, and reported on problematic Internet use with the Compulsive Internet Use Scale (CIUS). To predict problematic Internet use (CIUS summary score), we conducted a multiple stepwise linear regression analysis with the seven FB-S scales, the FB-S overall index, and gender and age as explanatory variables. For the full sample, a model with only one predictor (FB-S overall index) that summarizes the quality of family functioning produced a corrected coefficient of determination of 0.239 and explained variance of nearly 24%. t Test results for unpaired samples showed significant differences in the mean values of the FB-S scales and the FB-S overall index for comparisons of both sexes, as well as of a lower age group and higher age group. The prediction of problematic Internet use between both sexes and both age groups showed comparable findings (males: corrected coefficient of determination=0.288; females: corrected coefficient of determination=0.183; lower age group: corrected coefficient of determination=0.231; higher age group: corrected coefficient of determination=0.251), each with a single predictor (FB-S overall index). The results emphasize the importance of family functioning for the occurrence of problematic Internet use in adolescents.

[The influence of quality management on job satisfaction and work load--exemplary study in a German hospital]. / Wie wirkt sich die Einführung des Qualitätsmanagements auf die Arbeitszufriedenheit und Arbeitsbelastung aus? Exemplarische Untersuchung in einer Klinik.

Surveys among employees are getting more and more relevant in hospital settings since an increase in both (1) efficiency and (2) quality in connection with (3) enhanced patient orientation will only be achieved, if at the same time the employees' health status and satisfaction are taken into account. Thus, the objective of this study was to compare the satisfaction of employees in a single hospital enquired in 2002 with that of 2005. Particular consideration was given to their view of quality management. Is there a correlation between employees' satisfaction, their degree of information on quality management, and their assessment of quality management? In the survey of 2005 employees were more satisfied with their work and their working conditions than in the previous inquiry conducted in 2002. They felt less mental stress, despite the declining length of hospitalisation combined with a higher turnover of in-hospital cases and with lower numbers of full-time staff. The employees' satisfaction, however, differed widely among the three departments with regard to the items "involvement with decisions" and "support by the superiors". The overall assessment of quality management is positive. Specific items such as the assessment of the management's commitment to quality management were strongly influenced by the employees' degree of information on quality management, which varies between departments. In the department with the lowest work satisfaction quality management was attributed a high potential for change and improvement. After quality management will have been implemented throughout the hospital, a new survey should be undertaken to evaluate whether quality management affects the employees' satisfaction with their work.

Familial aggregation of depression, but no familial aggregation of individual depressive symptoms.

BACKGROUND: Familial aggregation of major depression might indicate a genetic liability for the disorder. The complete disorder or, alternatively, only some individual symptoms might be inherited. Under the latter condition, an increased frequency of inherited symptoms might consecutively increase the likelihood to reach the threshold for depression in relatives and, thus, might cause the familial aggregation of depression. Up to now, no study investigated the possibility of a relationship between individual depressive symptoms and the familial aggregation of depression. METHODS: The familial aggregation of early-onset depression (age-at-onset < 60 years, EOD) but less so of late-onset depression (LOD) has been shown in this sample. To assess the hypothesis of an inheritance of individual depressive symptoms as a possible cause of the familial aggregation of depression, frequencies of symptoms were compared in relatives of depressed patients and of controls using forward logistic regression analyses. RESULTS: Some individual depressive symptoms showed clustering in relatives of patients with depression, but the pattern of inheritance was inconsistent, i.e. the clustering of symptoms was different between non-depressed and depressed relatives of patients with EOD and LOD, respectively. No intra-familial clustering of specific depressive symptoms within families of depressed subjects could be observed. CONCLUSIONS: Due to the inconsistencies in the clustering of individual symptoms in non-depressed and depressed relatives and the lack of intra-familial clustering, the familial aggregation of depression is unlikely to be caused by the aggregation of individual depressive symptoms. An inheritance of the vulnerability for complete depressive disorders influenced by environmental factors is more likely.

Risk factors of major depression in the elderly.

BACKGROUND: Several risk factors of depression have been identified in retrospective as well as some prospective studies in the elderly. Confirmation in independent samples is needed. The present follow-up study prospectively investigated risk factors of depression in an elderly German sample. METHODS: One thousand four hundred and thirty-one subjects from a family study were re-investigated after 4.7 +/- 2.5 years. Bivariate and multivariate forward logistic regression analyses were used to identify risk factors of the development of new depression in the elderly. RESULTS: Risk factors of a new depressive episode in 1408 elderly without current depression were age, female gender, a previous depression, subjective memory impairment, previous anxiety and somatoform disorders. The presence of dementia or mild cognitive impairment were significant risk factors in bivariate, but not multivariate analysis controlling for possible confounding. Risk factors of a first geriatric depressive episode were age, gender and subjective memory impairment; age remained the only significant risk factor in multivariate analysis. CONCLUSIONS: This investigation confirms previous studies from other countries concerning the relevance of risk factors for depression in the elderly. The knowledge of risk factors might help identify subjects at increased risk of depression for early intervention approaches. Elderly with a history of previous depression carry the highest risk.

Lifetime depressive and somatic symptoms as preclinical markers of late-onset depression.

BACKGROUND: Several risk factors of depression, i. e., female gender and life-stress, have been identified. Few studies have focussed on symptoms as preclinical markers of depression. In these studies current symptoms like dysphoria, tiredness and increased appetite predicted later depression. Even though of possible interest for treatment, no study focussed on lifetime symptoms as preclinical markers of depression. Consequently, we examined lifetime depressive and somatic symptoms with respect to later development of late-onset depression. METHODS: 664 non-depressed elderly subjects without lifetime diagnoses of depression at the initial examination were selected for a prospective follow-up study (mean follow-up +/- SD: 5.02 +/- 2.44 years). 51 subjects (mean age +/- SD: 66.6 +/- 11.3) developing late-onset depression (defined as depression starting after age 60) were compared to those remaining non-depressed (mean age +/- SD: 59.1 +/- 16.0) during follow-up using the CIDI. To determine the influence of lifetime symptoms on the development of depression, chi-square statistics and multivariate logistic regression analyses were performed. RESULTS: The following symptoms being present over a period longer than two weeks were individual preclinical markers of late-onset depression: dysphoria, increased appetite, insomnia, lack of energy, morning depth, lack of joy and interest, inferiority feeling, lack of self-confidence, poor concentration, indecisiveness, thinking about death, wish to die and joint pain. The most important symptoms elevating the risk of late-onset depression in a multivariate model were lack of joy and interest, poor concentration, increased appetite, lack of energy and joint pain. CONCLUSIONS: Different symptoms can be used individually and in combination to predict later depression. This might allow early treatment.

Reversed circadian rhythms of heart rate variability and morning peak occurrence of sustained ventricular tachyarrhythmias in patients with implanted cardioverter defibrillator.

BACKGROUND: It is generally supposed that diurnal fluctuations of heart rate variability (HRV) are associated with diurnal variability of occurrence of sudden cardiac death, usually caused by tachyarrhythmias. To date, however, there have been no data comparing circadian rhythms of HRV and circadian variability of malignant ventricular tachyarrhythmias in the same patients. MATERIAL/METHODS: We studied 20 consecutive recipients of implantable cardioverter defibrillators in long-term follow-up, comparing the circadian rhythms of HRV in patients with and without typical morning peak occurrence of ventricular tachyarrhythmias. RESULTS: The HRV marker of vagus activity (RMSSD and HF power) displayed physiological circadian variability (highest values during sleep time, morning dip) only in patients without morning peak of arrhythmic events, and inverse circadian variability in patients with tachyarrhythmic morning peak. The variations in LF power and LF/HF ratio in both groups were not statistically significant, but with respect to the time interval between midnight and noon again showed inverse diurnal variation in patients with and without morning peak of arrhythmic events. CONCLUSIONS: These data suggest an association between a reversed circadian rhythm of HRV and morning peak frequency of tachyarrhythmic events in patients with ICD. As pronounced adrenergic hyperactivity in heart failure is the probable reason for paradoxically reversed circadian HRV variation, this association supports the hypothesis that the morning peak frequency of cardiovascular events may be interpreted as a sign of cardiovascular overload by the natural change from sleep to activity after awakening.