Radiologist assistant: best fit for medical imaging.

The radiologist assistant (RA) is an emerging mid-level provider who can benefit radiologists, technologists, radiology departments, patients, and the healthcare system in the United States. A review of the peer-reviewed literature published from 2005-2013 revealed a moderate amount of research about these benefits, which was supplemented with research on collaborative relationships and advanced practice registered nurses (APRN). As an advanced practice radiologic technologist, the RA has a strong technically based, patient-centered background and is the ideal mid-level provider in an imaging-centered clinical environment.

A meta-analysis of placebo-controlled clinical trials assessing the efficacy and safety of incretin-based medications in patients with type 2 diabetes.

AIMS: A systematic review of the literature, in combination with a meta-analysis of randomized controlled trials comparing treatments with placebo, was conducted to provide an update on the clinical efficacy and safety of incretin-based medications in adult patients with type 2 diabetes. METHODS: A literature search (2000-2009) identified 38 placebo-controlled trials (phase II or later - parallel design) comparing exenatide (n = 8), liraglutide (n = 7), vildagliptin (n = 11) and sitagliptin (n = 12) with placebo. Outcomes were change from baseline in HbA(1c) and in weight, and the number of patient-reported hypoglycemic episodes. HbA(1c) and weight outcomes were analyzed as weighted mean differences (WMD), and the number of hypoglycemic episodes as relative risks (RR). RESULTS: Patients receiving liraglutide showed greater reduction in HbA(1c) in comparison to placebo (WMD = -1.03, 95% confidence interval, CI = -1.16 to -0.90, p < 0.001) than those on sitagliptin (WMD = -0.79, 95% CI = -0.93 to -0.65, p < 0.001), exenatide (WMD = -0.75, 95% CI = -0.83 to -0.67, p < 0.001) or vildagliptin (WMD = -0.67, 95% CI = -0.83 to -0.52, p < 0.001). Weight was statistically significantly negatively associated with exenatide (WMD = -1.10, 95% CI = -1.32 to -0.87, p < 0.001) and positively associated with sitagliptin (WMD = 0.60, 95% CI = 0.33-0.87, p < 0.001) and vildagliptin (WMD = 0.56, 95% CI = 0.27-0.84, p < 0.001). The number of patient-reported hypoglycemic episodes was statistically significantly associated with the use of sitagliptin (RR = 2.56, 95% CI = 1.23-5.33, p = 0.01) and exenatide (RR = 2.40, 95% CI = 1.30-4.11, p = 0.002). CONCLUSION: Incretin-based therapies are effective in glycemic control and also offer other advantages such as weight loss (exenatide and liraglutide). This may have an important impact on patient adherence to medication.

Nursing in a Community With Leprosy at the Center: A Conversation With Remi Kalnime.

Donna Wright, a consultant with Creative Health Care Management who has wide experience in international nursing, interviews Remi Kalnime, a nurse who cares for patients who have had Hansen's Disease, at Foubarka Leprosarium in Cameroon, Africa. They discuss the challenges these patients and their families face in dealing with the residual effects of untreated leprosy and in facing stigmatization and discrimination from their communities, within the socioeconomic context of a developing country.

Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?

BACKGROUND: Mental health interventions should demonstrate an effect on patients' functioning as well as his/her needs, in particular on unmet needs whose assessment depends on the perspective of either the patient or the clinician. However, individual met and unmet needs appear to change over time, qualitatively and quantitatively, raising questions about their sensitivity to change and about the association between level of needs and treatment. METHODS: Data on baseline and follow-up need assessment in community mental health services in four European countries in the context of a cluster randomised trial on a novel mental health service intervention were used, which involved 102 clinicians with key worker roles and 320 patients with schizophrenia or related psychotic disorders. Need assessment was performed with the Camberwell assessment of needs short appraisal schedule (CANSAS) among patients as well as clinicians. Focus is the sensitivity to change in unmet needs over time as well as the concordance between patient and clinician ratings and their relationship with treatment condition. RESULTS: At follow-up 294 patients (92%) had a full need assessment, while clinician rated needs were available for 302 patients (94%). Generally, the total number of met needs remained quite stable, but unmet needs decreased significantly over time, according to patients as well as to clinicians. Sensitivity to change of unmet needs is quite high: about two third of all unmet needs made a transition to no or met need, and more than half of all unmet needs at follow-up were new. Agreement between patient and clinician on unmet needs at baseline as well as follow-up was rather low, without any indication of a specific treatment effect. CONCLUSIONS: Individual unmet needs appear to be quite sensitive to change over time but as yet less suitable as outcome criterion of treatment or specific interventions.

Mental health care institutions in nine European countries, 2002 to 2006.

OBJECTIVE: Although mental health reforms in the 20th century were characterized by deinstitutionalization, previous research suggested a new era of reinstitutionalization in six European countries between 1990 and 2002. This study aimed to establish whether there has been a trend in Europe toward more institutionalized care since 2002. METHODS: Primary data sources were used to collect data on conventional inpatient beds, involuntary hospital admissions, forensic beds, places in residential care and supervised and supported housing, and the prison population in nine countries: Austria, Denmark, England, Germany, Republic of Ireland, Italy, the Netherlands, Spain, and Switzerland. RESULTS: Between 2002 and 2006 the number of conventional psychiatric inpatient beds tended to fall and changes in involuntary admissions were inconsistent. The number of forensic beds, places in supervised and supported housing, and the prison population increased in most, but not all, of the countries studied. CONCLUSIONS: The findings suggest an ongoing although not consistent trend toward increasing provision of institutionalized mental health care across Europe.

The Cost-effectiveness of Dulaglutide 1.5mg versus Exenatide QW for the Treatment of Patients with Type 2 Diabetes Mellitus in France.

INTRODUCTION: Dulaglutide is a novel onceweekly administered glucagon-like peptide 1 receptor agonist (GLP-1 RA) for the management of type 2 diabetes mellitus (T2DM). The objective of this analysis was to estimate the cost-effectiveness of dulaglutide 1.5 mg versus exenatide QW for the management of T2DM in France. METHODS: The QuintilesIMS CORE Diabetes Model was used to estimate the expected lifetime direct medical costs and outcomes of T2DM from the perspective of the French National Health Service. In the absence of head-to-head data, relative efficacy was derived from a network meta-analysis. Patient cohort characteristics were derived from the AWARD-2 trial. All patients were assumed to remain on treatment for 2 years before escalating to insulin therapy. Costs included treatment costs and costs associated with long-term complications of T2DM. Utilities were estimated based on a recent systematic review. One-way sensitivity analyses (OWSA) and probabilistic sensitivity analysis (PSA) were conducted. Cost-effectiveness acceptability curves (CEACs) were generated. RESULTS: Dulaglutide 1.5 mg was associated with lower costs (lifetime costs €41,562 vs €43,021) and increased health benefits (lifetime quality-adjusted life years: QALYs 9.804 vs 9.757) versus exenatide QW for the treatment of T2DM in France. OWSA and PSA indicated that results were robust across a range of plausible input parameters. The CEAC indicated a 99.5% probability that dulaglutide would be considered cost-effective at a willingness to pay of €30,000. CONCLUSION: Dulaglutide 1.5 mg reduced expected costs and increased expected QALYs when compared against exenatide QW for the treatment of T2DM in France. Compared with exenatide QW, dulaglutide 1.5 mg can provide additional health benefits for patients with T2DM and may result in cost savings for payers. FUNDING: Eli Lilly.

Leadership theory and motivation of medical imaging employees.

*This literature review explores how transactional, transformational, and charismatic leadership theories might be applied in a typical stressful hypothetical department situation. *Transactional department leaders motivate employees using extrinsic rewards, encouraging them to do what is needed to get the minimal results with no encouragement for higher levels of thinking. *Transformational department leaders motivate employees by transforming their beliefs and values to be more in alignment with the organization's values and goals. This alignment helps create higher levels of intrinsic motivation. *Charismatic leaders exhibit the same behaviors as transformational leaders to motivate employees; however; because of their specific characteristics, their effectiveness can be limited to only times of distress or crisis. The situation in the particular department determines which leadership theory is likely to be most successful.

Rural radiology services in Texas: an assessment in quality.

Health professionals share a common interest in improving the quality of healthcare provided to the notion's underserved citizens, many who live in rural areas. This article examines the quality of radiology services found in rural Texas hospitals as reported by radiology managers through online survey research in terms of staffing, radiologist availability, and quality control measures. A 22 question survey was developed and 72 of 106 possible responses were obtained for a 67.9% response rate representing 45% of the total population. Texas is a licensure state for radiologic technologists. Texas rural counties with fewer than 50 thousand citizens have only 9% of MRTs, 10% of LMRTs, and 12% of NCTs licensed to practice radiology imaging. Licensing all three levels of technologists through the some administrative body could result in more standard educational and training requirements, thereby increasing the quality of care given by these individuals. Patients seen at lower-volume rural facilities benefit from convenient scheduling and lower prices and are beginning to see faster reporting with the prevalence of teleradiology and voice recognition dictation.

Admission requirements for radiography programs.

CONTEXT: Radiography program applicants far outnumber available class capacity in many programs. Educational accountability requires that programs justify their admission practices, work to retain all qualified students and evaluate their attrition rates. Thus, radiography programs are interested in identifying the best candidates for admission. PURPOSE: The purpose of this small survey study was to document admission requirements of entry-level programs in radiography accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT) in Oklahoma and Texas. METHODS: A 14-question survey was sent to 45 JRCERT-accredited entry-level radiography programs in Oklahoma and Texas. The survey included questions concerning program demographics, admission criteria and admission practices. RESULTS: Cumulative grade point average, interviews, successful completion of math and science courses, and performance on standardized tests were the most commonly used admission criteria, although no criteria were used by all of the programs surveyed. CONCLUSION: The current study is the first step toward identifying the most effective admission criteria for radiography programs. Future research should examine the correlation of specific admission criteria with program success (ie, program retention, program completion and professional certification).

The effect of salts on the activity and stability of Escherichia coli and Haloferax volcanii dihydrofolate reductases.

The extremely halophilic Archae require near-saturating concentrations of salt in the external environment and in their cytoplasm, potassium being the predominant intracellular cation. The proteins of these organisms have evolved to function in concentrations of salt that inactivate or precipitate homologous proteins from non-halophilic species. It has been proposed that haloadaptation is primarily due to clustering of acidic residues on the surface of the protein, and that these clusters bind networks of hydrated ions. The dihydrofolate reductases from Escherichia coli (ecDHFR) and two DHFR isozymes from Haloferax volcanii (hvDHFR1 and hvDHFR2) have been used as a model system to compare the effect of salts on a mesophilic and halophilic enzyme. The KCl-dependence of the activity and substrate affinity was investigated. ecDHFR is largely inactivated above 1M KCl, with no major effect on substrate affinity. hvDHFR1 and hvDHFR2 unfold at KCl concentrations below approximately 0.5M. Above approximately 1M, the KCl dependence of the hvDHFR activities can be attributed to the effect of salt on substrate affinity. The abilities of NaCl, KCl, and CsCl to enhance the stability to urea denaturation were determined, and similar efficacies of stabilization were observed for all three DHFR variants. The DeltaG degrees (H(2)O) values increased linearly with increasing KCl and CsCl concentrations. The increase of DeltaG degrees (H(2)O) as a function of the smallest cation, NaCl, is slightly curved, suggesting a minor stabilization from cation binding or screening of electrostatic repulsion. At their respective physiological ionic strengths, the DHFR variants exhibit similar stabilities. Salts stabilize ecDHFR and the hvDHFRs by a common mechanism, not a halophile-specific mechanism, such as the binding of hydrated salt networks. The primary mode of salt stabilization of the mesophilic and halophilic DHFRs appears to be through preferential hydration and the Hofmeister effect of salt on the activity and entropy of the aqueous solvent. In support of this conclusion, all three DHFRs are similarly stabilized by the non-ionic cosolute, sucrose.

Growing your own: planting seeds for healthy rural hospitals.

Rural areas continually suffer from shortages of healthcare providers and healthcare professionals. Although research exists that addresses unique problems and opportunities associated with rural medical careers, little contributes to the development of providers from within the community. This article proposes a new approach to alleviating the shortage of rural healthcare professionals by looking toward the community's youth.

Recruiting healthcare professionals to rural areas.

Maintaining an adequate number of healthcare providers for the nation's most underserved populations is increasingly diffiicult. Rural medical services have issues that often complicate recruitment and retention of qualified medical professionals. This review of literature examines some of the issues unique to rural areas. Consideration of these issues during recruitment strategies may lead to increased recruitment and retention of healthcare professionals to ruraI areas.

Expanding the scope of practice for radiology managers: radiation safety duties.

In addition to financial responsibilities and patient care duties, many medical facilities also expect radiology department managers to wear "safety" hats and complete fundamental quality control/quality assurance, conduct routine safety surveillance in the department, and to meet regulatory demands in the workplace. All managers influence continuous quality improvement initiatives, from effective utilization of resource and staffing allocations, to efficacy of patient scheduling tactics. It is critically important to understand continuous quality improvement (CQI) and its relationship with the radiology manager, specifically quality assurance/quality control in routine work, as these are the fundamentals of institutional safety, including radiation safety. When an institution applies for a registration for radiation-producing devices or a license for the use of radioactive materials, the permit granting body has specific requirements, policies and procedures that must be satisfied in order to be granted a permit and to maintain it continuously. In the 32 U.S. Agreement states, which are states that have radiation safety programs equivalent to the Nuclear Regulatory Commission programs, individual facilities apply for permits through the local governing body of radiation protection. Other states are directly licensed by the Nuclear Regulatory Commission and associated regulatory entities. These regulatory agencies grant permits, set conditions for use in accordance with state and federal laws, monitor and enforce radiation safety activities, and audit facilities for compliance with their regulations. Every radiology department and associated areas of radiation use are subject to inspection and enforcement policies in order to ensure safety of equipment and personnel. In today's business practice, department managers or chief technologists may actively participate in the duties associated with institutional radiation safety, especially in smaller institutions, while other facilities may assign the duties and title of "radiation safety officer" to a radiologist or other management, per the requirements of regulatory agencies in that state. Radiation safety in a medical setting can be delineated into two main categories--equipment and personnel requirements--each having very specific guidelines. The literature fails to adequately address the blatant link between radiology department managers and radiation safety duties. The breadth and depth of this relationship is of utmost concern and warrants deeper insight as the demands of the regulatory agencies increase with the new advances in technology, procedures and treatments associated with radiation-producing devices and radioactive materials.

Reducing blood stream infections during catheter insertion.

BACKGROUND: Registered radiologist assistants (R.R.A.s) and other health care providers frequently are responsible for placing peripherally inserted central catheter (PICC) lines. Postprocedure blood stream infections are a potentially costly and medically serious complication. PURPOSE: To determine the most effective methods for R.R.A.s and other health professionals to reduce blood stream infections related to PICC line insertion and management. METHODS: Using specific inclusion criteria, the authors searched for scholarly reviewed articles related to PICC lines, infection, and adulthood. RESULTS: The search produced 2237 articles, from which the authors selected 35 for review, in addition to 6 articles identified in the reference lists of articles not selected. The authors investigated 6 topics related to infection control in PICCs among nonimmunocompromised adults: securement devices, staff education, needleless systems, site preparation, maximum sterile barriers, and antimicrobial patches. CONCLUSION: In the long run, proactive continuing education is less expensive than the cost of complications caused by postprocedure infections. Although further research is needed, specific strategies reported in the literature included prepping the skin using chlorhexidine and antimicrobial patches to reduce the microorganisms in the area. These steps should be followed by maximum sterile barriers. Needleless connectors and positive-pressure valves were found to be more effective than the alternatives, and proper securement with self-adhesive anchoring devices was found to be more effective than suturing for reducing blood stream infections.

Modeling the lifetime costs of insulin glargine and insulin detemir in type 1 and type 2 diabetes patients in Canada: a meta-analysis and a cost-minimization analysis.

BACKGROUND: Two basal insulin analogues, insulin glargine once daily and insulin detemir once or twice daily, are marketed in Canada. OBJECTIVE: To estimate the long-term costs of insulin glargine once daily (QD) versus insulin detemir once or twice daily (QD or BID) for type 1 (T1DM) and type 2 (T2DM) diabetes mellitus from a Canadian provincial government's perspective. METHODS: A cost-minimization analysis comparing insulin glargine (IGlarg) to insulin detemir (IDet) was conducted using a validated computer simulation model, the CORE Diabetes Model. Lifetime direct medical costs including costs of insulin treatment and diabetes complications were projected. T1DM and T2DM patients' daily insulin dose (T1DM: IGlarg QD 26.2 IU; IDet BID 33.6 IU; T2DM: IGlarg QD 47.2 IU; IDet QD 65.7 IU or IDet BID 80.4 IU) was derived from a meta-analysis of randomized trials. All patients were assumed to stay on the same treatment for life. Costs were discounted at 5% per annum and reported in 2010 Canadian Dollars. RESULTS: The meta-analysis showed T1DM and T2DM patients had similar HbA(1c) change from baseline when receiving IGlarg compared to IDet (T1DM: 0.002%-points; p = 0.97; T2DM: -0.05%-points; p = 0.28). Treatment of T1DM patients with IGlarg versus IDet BID resulted in lifetime cost savings of $4231 per patient. Treatment of T2DM patients with IGlarg resulted in lifetime cost savings of $4659 per patient versus IDet QD and cost savings of $8709 per patient versus IDet BID. CONCLUSIONS: Similar HbA(1c) change from baseline can be achieved with a lower IGlarg than IDet dose. From the perspective of a Canadian provincial government, treatment of T1DM and T2DM patients with IGlarg instead of IDet can generate long-term cost savings. Main limitations include trial data were derived from multi-country studies rather than the Canadian population and self-monitoring blood glucose costs were not included.