Combined lumbar spine MRI and CT appropriateness checklist: a quality improvement project in Saskatchewan, Canada.

BACKGROUND: As rates of advanced imaging for lower back pain (LBP) continue to increase, there is a need to ensure the appropriateness of imaging. OBJECTIVE: The goal of this project was to reduce the number of inappropriate magnetic resonance imaging (MRI) and computed tomography (CT) requests for LBP patients and facilitate appropriate imaging by developing a combined imaging appropriateness checklist for lumbar spine MRI and CT. METHODS: In prior work, we developed and adopted individual evidence-based lumbar spine MRI and CT checklists into the radiology requisition process. In the current project, a combined checklist was developed and trialed in one of the former Saskatchewan health regions (Five Hills) beginning in May 2018. Using statistical process control, control charts compared the monthly number of imaging requests pre-checklist implementation and post-checklist implementation from May 2017 to February 2020. The monthly number of lumbar spine MRI and CT requisitions in the nearby former Saskatchewan Regina Qu'Appelle Health Region, in which the combined checklist was not trialed, was also plotted and compared as a balancing measure. RESULTS: In Five Hills, a shift (decrease) was observed in the monthly number of lumbar spine MRI requisitions 7 months following the implementation of the combined checklist. However, the monthly number of lumbar spine CT requisitions did not change significantly. In the Regina Qu'Appelle Health Region, there was a shift (increase) in the monthly number of lumbar spine MRI requisitions, while the monthly number of lumbar spine CT requests decreased after the implementation of the combined checklist. CONCLUSIONS: The combined checklist with evidence-based indications for lumbar spine MRI and CT imaging in LBP patients appeared to reduce the complexity associated with two previous individual checklists and facilitate imaging appropriateness. Accountable benefits may include the reduction of radiation exposure as a result of unnecessary and repeated imaging and reduction in wait times for CT and/or MRI.

Comprehensive review of water management and wastewater treatment in food processing industries in the framework of water-food-environment nexus.

Food processing is among the greatest water-consuming industries with a significant role in the implementation of sustainable development goals. Water-consuming industries such as food processing have become a threat to limited freshwater resources, and numerous attempts are being carried out in order to develop and apply novel approaches for water management in these industries. Studies have shown the positive impact of the new methods of process integration (e.g., water pinch, mathematical optimization, etc.) in maximizing water reuse and recycle. Applying these methods in food processing industries not only significantly supported water consumption minimization but also contributed to environmental protection by reducing wastewater generation. The methods can also increase the productivity of these industries and direct them to sustainable production. This interconnection led to a new subcategory in nexus studies known as water-food-environment nexus. The nexus assures sustainable food production with minimum freshwater consumption and minimizes the environmental destructions caused by untreated wastewater discharge. The aim of this study was to provide a thorough review of water-food-environment nexus application in food processing industries and explore the nexus from different aspects. The current study explored the process of food industries in different sectors regarding water consumption and wastewater generation, both qualitatively and quantitatively. The most recent wastewater treatment methods carried out in different food processing sectors were also reviewed. This review provided a comprehensive literature for choosing the optimum scenario of water and wastewater management in food processing industries.

Development of a Patient-Oriented Intervention to Support Patient-Provider Conversations about Unnecessary Lower Back Pain Imaging.

BACKGROUND: despite the efforts of multiple stakeholders to promote appropriate care throughout the healthcare system, studies show that two out of three lower back pain (LBP) patients expect to receive imaging. We used the Choosing Wisely Canada patient-oriented framework, prioritizing patient engagement, to develop an intervention that addresses lower back pain imaging overuse. METHODS: to develop this intervention, we collaborated with a multidisciplinary advisory team, including two patient partners with lower back pain, researchers, clinicians, healthcare administrators, and the Choosing Wisely Canada lead for Saskatchewan. For this qualitative study, data were collected through two advisory team meetings, two individual interviews with lower back pain patient partners, and three focus groups with lower back pain patient participants. A lower back pain prescription pad was developed as an outcome of these consultations. RESULTS: participants reported a lack of interactive and informative communication was a significant barrier to receiving appropriate care. The most cited content information for inclusion in this intervention was treatments known to work, including physical activity, useful equipment, and reliable sources of educational material. Participants also suggested it was important that benefits and risks of imaging were explained on the pad. Three key themes derived from the data were also used to guide development of the intervention: (a) the role of imaging in LBP diagnosis; (b) the impact of the patient-physician relationship on LBP diagnosis and treatment; and (c) the lack of patient awareness of Choosing Wisely Canada and their recommendations. CONCLUSIONS: the lower back pain patient-developed prescription pad may help patients and clinicians engage in informed conversations and shared decision making that could support reduce unnecessary lower back pain imaging.