Impact of a targeted temperature management quality improvement project on survival and neurologic outcomes in cardiac arrest patients.

BACKGROUND: Targeted temperature management (TTM) is recommended for postresuscitation care of patients with sudden cardiac arrest (SCA) and its implementation remains challenging. This study aimed to evaluate the newly designed Quality Improvement Project (QIP) to improve the quality of TTM and outcomes of patients with SCA. METHODS: Patients who experienced out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) with return of spontaneous circulation (ROSC) and were treated in our hospital between January 2017 and December 2019 were enrolled retrospectively. All included patients received QIP intervention initiated as follows: (1) Protocols and standard operating procedures were created for TTM; (2) shared decision-making was documented; (3) job training instruction was created; and 4) lean medical management was implemented. RESULTS: Among 248 included patients, the postintervention group (n = 104) had shorter duration of ROSC to TTM than the preintervention group (n = 144) (356 vs 540 minutes, p = 0.042); better survival rate (39.4% vs 27.1%, p = 0.04), and neurologic performance (25.0% vs 17.4%, p < 0.001). After propensity score matching (PSM), patients who received TTM (n = 48 ) had better neurologic performance than those without TTM (n = 48) (25.1% vs 18.8%, p < 0.001). OHCA (odds ratio [OR] = 2.705, 95% CI: 1.657-4.416), age >60 (OR = 2.154, 95% CI: 1.428-3.244), female (OR = 1.404, 95% CI: 1.005-1.962), and diabetes mellitus (OR = 1.429, 95% CI: 1.019-2.005) were negative predictors of survival; while TTM (OR = 0.431, 95% CI: 0.266-0.699) and bystander cardiopulmonary resuscitation (CPR) (OR=0.589, 95% CI: 0.35-0.99) were positive predictors. Age >60 (OR= 2.292, 95% CI: 1.58-3.323) and OHCA (OR= 2.928, 95% CI: 1.858-4.616) were negative predictors of favorable neurologic outcomes; while bystander CPR (OR=0.572, 95% CI: 0.355-0.922) and TTM (OR=0.457, 95% CI: 0.296-0.705) were positive predictors. CONCLUSION: A new QIP with defined protocols, documented shared decision-making, and medical management guidelines improves TTM execution, duration from ROSC to TTM , survival, and neurologic outcomes of cardiac arrest patients.

3D Shape-Weighted Level Set Method for Breast MRI 3D Tumor Segmentation.

Three-dimensional (3D) medical image segmentation is used to segment the target (a lesion or an organ) in 3D medical images. Through this process, 3D target information is obtained; hence, this technology is an important auxiliary tool for medical diagnosis. Although some methods have proved to be successful for two-dimensional (2D) image segmentation, their direct use in the 3D case has been unsatisfactory. To obtain more precise tumor segmentation results from 3D MR images, in this paper, we propose a method known as the 3D shape-weighted level set method (3D-SLSM). The proposed method first converts the LSM, which is superior with respect to 2D image segmentation, into a 3D algorithm that is suitable for overall calculations in 3D image models, and which improves the efficiency and accuracy of calculations. A 3D shape-weighted value is then added for each 3D-SLSM iterative process according to the changes in volume. Besides increasing the convergence rate and eliminating background noise, this shape-weighted value also brings the segmented contour closer to the actual tumor margins. To perform a quantitative analysis of 3D-SLSM and to examine its feasibility in clinical applications, we have divided our experiments into computer-simulated sequence images and actual breast MRI cases. Subsequently, we simultaneously compared various existing 3D segmentation methods. The experimental results demonstrated that 3D-SLSM exhibited precise segmentation results for both types of experimental images. In addition, 3D-SLSM showed better results for quantitative data compared with existing 3D segmentation methods.