Learning from experience - Radiology ancillary review of prospective research studies involving imaging.

This report describes the operational process of a big academic children's hospital's Radiology Scientific Review Committee, with a focus on its role in integrating radiology services into pediatric clinical research. We define the step-by-step workflow used to assess research proposals involving imaging and share insights from the past three years of data collection. Trends in modalities, radiologist involvement, and interpretation possibilities are outlined in the data. This systematic methodology provides essential resource allocation concepts and promotes high-quality pediatric clinical research.

A "global village": promoting research and careers in the pediatric radiology community through diversity.

There is a severe shortage of pediatric radiologists in the USA and across the globe due to multiple factors. These severe shortages, along with increased clinical demand, growing research costs and limited funding sources place pediatric radiologists, particularly those in academic departments, under increasing time pressure, affecting their ability to maintain research productivity. In this paper, we model a new concept that should help boost the research efforts within the pediatric radiology community, while diversifying the academic workforce through the involvement of international medical graduates (IMGs). We describe the mutual advantages this concept could have on academic pediatric radiology departments and IMGs alike, as well as pose some of the unique challenges that could impact this concept and effective strategies to ensure success.

Hands-On Ultrasound Training for Radiology Residents: The Impact of an Ultrasound Scanning Curriculum.

RATIONALE AND OBJECTIVES: Radiologists are responsible for interpreting ultrasound (US) images accurately, troubleshooting, aiding sonographers, and advancing technology and research. Despite this, most radiology residents do not feel confident performing US independently. The purpose of this study is to evaluate the impact of an abdominal US scanning rotation and digital curriculum on radiology residents' confidence and skills in performing US. MATERIALS AND METHODS: All residents who were rotating in pediatric US at our institution for the first time were included (PGY 3-5). Those who agreed to participate were recruited sequentially from July 2018 to 2021 into (A) control and (B) intervention. B had a 1-week US scanning rotation and US digital course. Both groups completed a pre-and post-confidence self-assessment. Pre-and post-skills were objectively assessed by an expert technologist while participants scanned a volunteer. At completion, B completed an evaluation of the tutorial. Descriptive statistics summarized the demographics and closed questions. Pre-and post-test results were compared using paired-T tests, and effect size (ES) with Cohen's d. Open-ended questions were thematically analyzed. RESULTS: PGY-3 and 4 residents participated, and were enrolled in A (N = 39) and B (N = 30). Scanning confidence significantly improved in both groups, with a greater ES in B (p < 0.01). Scanning skills significantly improved in B (p < 0.01) but not A. Eighty per cent of questionnaire responders used the integrative US tutorial and found it helpful. Free text responses were grouped into themes: 1) Technical issues, 2) Didn't complete course, 3) Didn't understand project, 4) Course was detailed and thorough. CONCLUSIONS: Our scanning curriculum improved residents' confidence and skills in pediatric US and may encourage consistency in training, thus promoting stewardship of high-quality US.

Evaluating the role of statins in prevention of preeclampsia: deeper insights into maternal cardiometabolic changes.

Pregnant women with gestational hypertension and/or preeclampsia, have derangements of atherogenic lipids in early pregnancy. Changes in maternal lipids can promote atherogenesis through endothelial injury. These alterations in serum lipid levels have been linked to adverse pregnancy outcomes and maternal morbidity and mortality. Several recent studies have examined maternal atherogenic profiles in early pregnancy, and their relationships to preeclampsia and other adverse pregnancy outcomes. Given their effects on reduction of endothelial dysfunction, inflammation, and plaque stabilization, statin therapies may have utility in prevention and treatment of preeclampsia. We sought to investigate this further by examining the association between dyslipidemia and preeclampsia, as well as the potential role of statins in the prevention of preeclampsia. We discuss the pathophysiology of placental dysfunction in preeclampsia, the safety profile of statins in pregnancy, and evaluate the potential utility of statins in pregnancy, based on recent studies, specifically for women at high risk of developing preeclampsia. The lipid-lowering, immunomodulatory, anti-inflammatory, and pleiotropic effects of statins may make them promising candidates for the prevention and treatment of preeclampsia. However, it is important to note that the clinical use of statin therapy to prevent preeclampsia has no support from current research and is not justified. A reasonably large trial of pravastatin reported no effect on preeclampsia but used limited dosing with the intervention performed only in women at high-risk of term preeclampsia. Further research in randomized controlled trials extending the parameters of statin dosing is needed to help determine if preeclampsia can be effectively prevented.

Cardio-Obstetrics: the Next Frontier in Cardiovascular Disease Prevention.

PURPOSE OF REVIEW: Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk factors who may be predisposed to CVD and offers a unique opportunity to not only recognize disease but also implement effective and long-lasting strategies for prevention. RECENT FINDINGS: Prevention begins before pregnancy, as preconception screening, counseling, and optimization of chronic diseases can improve maternal and fetal outcomes. Throughout pregnancy, women should maintain close follow-up, continued reevaluation of risk factors, with counseling when necessary. Continued healthcare engagement during the "fourth trimester," 3 months following delivery, allows clinicians to continue monitoring the evolution of chronic diseases, encourage ongoing lifestyle counseling, and connect women with primary care and appropriate specialists if needed. Unfortunately, this postpartum period represents a major care gap, as a significant proportion of most women do not attend their scheduled visits. Social determinants of health including decreased access to care and economic instability lead to increased risk factors throughout pregnancy but particularly play a role in poor compliance with postpartum follow-up. The use of telemedicine clinics and remote monitoring may prove to be effective interventions, bridging the gap between physicians and patients and improving follow-up for at-risk women. While many clinicians are beginning to understand the impact of CVD on women, screening and prevention strategies are not often implemented until much later in life. Pregnancy creates an opportunity to begin engaging women in cardiovascular protective strategies before the development of the disease.

Pediatric magnetic resonance imaging training versus job-readiness: using education research tools to re-align.

BACKGROUND: Fellows begin MRI training with variable experience and expertise. To better serve patients, pediatric radiology fellows should gain competence in MRI that enables seamless transition to independent practice. OBJECTIVE: We implemented a needs assessment survey and conducted a focus group discussion to identify knowledge gaps and inform creation of a curriculum for pediatric body MRI. MATERIALS AND METHODS: We electronically distributed a comprehensive anonymous needs assessment survey in October 2016 to current fellows and recent (<5 years) graduates from Accreditation Council for Graduate Medical Education (ACGME)-accredited pediatric radiology fellowships, with follow-up in January 2017. We conducted a focus group discussion among current fellows at our institution in October 2017 to inform a better understanding of the results. RESULTS: Eighty-one pediatric radiologists (8 fellows/73 attendings) completed the survey (24%); 5 current fellows participated in the focus group. The technical issues most commonly identified with limited or no instruction during training included setting up an MR service, accessory equipment (coil) selection and MRI field inhomogeneity correction. Areas needing increased attention and inclusion within the curriculum included coil choice/patient positioning (n=42, 52%), contrast agents (n=40, 49%), field strength (n=33, 41%) and strategies for motion correction (n=33, 41%). Most fellows were uncomfortable with setting up an MR service (n=57, 70%), correcting field inhomogeneity (n=56, 69%) and improving image quality (n=50, 62%). The focus group showed consensus that there was insufficient MR training in residency to prepare them for fellowship. The group also preferred shorter lectures and streaming via video education/tutorials. CONCLUSION: While traditional instruction emphasizes image interpretation, trainees in pediatric radiology need a curriculum that also emphasizes technical and non-interpretive aspects of MRI.

Optimizing Radiology Reading Room Design: The Eudaimonia Radiology Machine.

Physical and mental stressors on radiologists can result in burnout. Although current efforts seek to target the issues of burnout and stress for radiologists, the impact of their physical workspace is often overlooked. By combining evidence-based design, human factors, and the architectural concept of the Eudaimonia Machine, we have developed a redesign of the radiology reading room that aims to create an optimal workspace for the radiologist. Informed by classical principles of well-being and contemporary work theory, Eudaimonia integrates concerns for individual wellness and efficiency to create an environment that fosters productivity. This layout arranges a work environment into purposeful spaces, each hosting tasks of varying degrees of intensity. The improved design addresses the radiologist's work requirements while also alleviating cognitive and physical stress, fatigue, and burnout. This new layout organizes the reading room into separate areas, each with a distinct purpose intended to support the range of radiologists' work, from consultation with other health care providers to reading images without interruption. The scientific principles that undergird evidence-based design and human factors considerations ensure that the Eudaimonia Radiology Machine is best suited to support the work of the radiologists and the entire radiology department.

Building a COVID-19 repository website for healthcare professionals in Ethiopia

Health professionals dealing with the COVID-19, both in clinical care and in the public health domain, require up-to-date and relevant scientific information. The Diaspora and Ethiopian Advisory Councils on the COVID-19 pandemic in Ethiopia joined forces with the Ethiopian Medical Association to create a local repository of compre-hensive peer-screened information on COVID-19. We describe the motivating factors for such a repository, the process of creating the website, and the utilization of this information resource for Ethiopian healthcare professionals.

Prevalence and Associated Factors of Thyroid Incidentaloma among Adult People Attending Gondar University Hospital, Northwest Ethiopia.

BACKGROUND: Incidentally discovered thyroid lesions have become highly common in the development and more frequent utilization of highly sensitive imaging modalities, like ultrasound. However, little is known about its prevalence and associated factors in Ethiopia. The aim of this study was to determine the prevalence of thyroid incidentalomas and associated factors through ultrasound (US) among adults attending Gondar University Hospital. METHODS: A hospital-based cross-sectional study was carried out on 290 adults aged 15 years and above. Out of the adults who visited the hospital during the study, those who neither had history of thyroid disease, thyroid surgery, nor clinically palpable thyroid nodules were involved in the investigation. The participants were examined using a high frequency linear-array transducer (7 MHz). For comparing men and women, the unpaired t-test was used. Binary logistic analysis was used to identify the associated factors, and a P-value < 0.05 was considered statistically significant. RESULT: The frequency of thyroid incidentaloma was found to be 33.4% (95% CI: 27.9, 38.9). Thyroid incidentaloma was detected in 42.4% of the females and 22.7% of the males (P<0.001). About 63% had single and 37% multiple thyroid nodules. About 25.8% had thyroid nodules greater than 1cm. In the multivariable logistic regression analysis, increasing age (AOR=5.96; 2.34, 15.15) and female sex (AOR=3.01; 1.73, 5.26) were significantly associated with thyroid incidentalomas. CONCLUSION: The frequency of thyroid incidentaloma (TI) was found to be high in this study and much higher among older women. Solitary and small sized thyroid nodules were commonly seen in the study.

'Walk in my shoes': intradepartmental role shadowing to increase workplace collegiality and wellness in a large pediatric radiology department.

BACKGROUND: Our nearly 500-member department implemented the shadowing program "Walk in My Shoes" to improve intradepartmental relationships and build a stronger sense of community. The program provides both clinical and non-clinical employees an opportunity to shadow colleagues in their various roles and learn more about one another's contribution to the overarching mission of caring for children and their families. The goal of this study was to understand the impact of the shadowing program on employee perceptions of various roles. OBJECTIVE: To bridge the gap of understanding among colleagues in order to strengthen workplace interrelatedness, increase understanding of various roles, and decrease preconceived notions about roles, through shadowing. MATERIALS AND METHODS: A preliminary survey distributed to our department in August 2018 assessed the level of interest in new wellness initiatives, including the shadowing program. The survey gauged which roles participants were interested in shadowing. The survey results revealed that 67 employees were interested in the shadowing program. We selected 39 participants and matched them to a coworker in their area of interest. The roles for shadowing included administrator, Child Life specialist, information technologist, medical assistant, nurse, radiologist, researcher and technologist. Participants were required to complete pre- and post-shadowing surveys to assess their experience. Individuals who hosted the shadow experience also completed a survey. RESULTS: A total of 39 clinical and non-clinical staff members participated in the program. We summarized the pre- and post-survey data using median and interquartile range (IQR) and compared the results using the Wilcoxon signed-rank test. The distribution of preconceived notions about each role was not significantly different between the pre- and post-surveys (P=0.094). However, participants' value, understanding of the role they shadowed, and understanding of how the roles relate to each other were significantly greater (P<0.001). In addition, participants showed great interest in shadowing the specific role again (82%) and shadowing another role (92%). Furthermore, almost all hosts would repeat the experience (96%). CONCLUSION: Our study showed that intradepartmental shadowing can improve clinical and non-clinical staff employees' perceptions and understanding of each other's roles in overall patient care, which in turn contributes to the broader initiative of workplace wellness. The enthusiasm and willingness of the hosts were essential for sustainability of the program and demonstrated that this type of program is feasible in a large, busy department.

"Together Make a Visit; Together Make a Plan": Messaging to Adult Children with Concerns about a Parent's Memory Loss.

Using the integrative model (IM), we developed and tested messages to encourage adults to accompany their parent to a memory doctor for a cognitive evaluation. We conducted in-depth interviews (n = 60) with African American and White adults with a parent age 65+ to identify key beliefs. Next, we carried out an IM-based telephone survey with a representative sample of the target population (n = 541). Analyses revealed that attitudes varied depending on the gender of the parent. Resulting messages featuring mothers countered the fear of hearing bad news and the belief that mother does not want to be accompanied to the doctor's office. Messages featuring fathers highlighted the belief that attending a doctor's visit will provide father emotional support. We subsequently tested messages with focus group participants (n = 48) and refined them. This study advances our understanding of opportunities to communicate about memory loss, including Alzheimer's disease and dementia, in ways that encourage a behavioral action that will benefit older adults and their families.

Optimizing Imaging Clinical Decision Support: Perspectives of Pediatric Emergency Department Physicians.

PURPOSE: The aim of this study was to solicit perspectives of pediatric emergency department physicians (PEDPs) to determine how software-based clinical decision support mechanisms (CDSMs) may integrate with existing imaging clinical decision support (ICDS) to optimize imaging utilization at the authors' institution. METHODS: Through qualitative interviews, the authors explored how PEDPs define ICDS, how they seek and obtain radiologist consultation, and how the rollout of CDSMs at the institution may potentially affect clinical practice. Codes were developed and explicitly defined through literature review and analysis of a subset of interviews. Coding results informed thematic categories used to develop an explanatory model. RESULTS: Analysis revealed three major thematic categories: (1) common influences on the decision process, (2) radiology consultation experience, and (3) PEDPs' perspectives on CDSMs. PEDPs described radiologist consultation as a valuable component of ICDS but reported difficulty in coordinating imaging strategies with radiologists and other subspecialists. PEDPs described the exchange of ideas as especially worthwhile for scenarios that do not fit neatly into clinical pathways. Barriers to radiologist consultation include time, access to radiologists, and not wanting to disrupt radiologists' workflow. PEDPs expressed optimism that CDSMs may improve their workflow and facilitate effective interaction with radiologists. CONCLUSIONS: PEDPs suggested that radiologist consultation will continue to be a valuable component of ICDS after the implementation of CDSMs by providing discussion-driven guidance to complement CDSM recommendations. The results also indicate that radiologists may consider strategies to facilitate effective interaction with PEDPs and reconcile conflicts of CDSMs with clinical practice.