'You make the call': Improving radiology staff scheduling with AI-generated self-rostering in a medical imaging department

INTRODUCTION

New Zealand's shortage of medical imaging technicians has intensified due to factors like illness, the pandemic, and an ageing workforce. Addressing staff retention issues requires attention to intrinsic factors like workplace satisfaction and work-life balance. Self-rostering has proven effective in healthcare by enhancing work-life balance, job satisfaction, and retention, but it has not been implemented widely in radiology. This study aimed to explore the perceptions, benefits, and challenges of implementing AI-generated self-rostering in a radiology department through simulated trials.

METHODS

This study simulated an AI-generated roster in a regional New Zealand radiology department, engaging 23 staff members. A mixed-methods approach included surveys and discussion groups. Community-based participatory action methodology guided discussion groups and informed modifications.

RESULTS

The AI-generated self-rostering method demonstrated success by meeting a high percentage of shift preferences while fulfilling service demands. Participants perceived potential benefits in work-life balance and autonomy, though uncertainties persisted regarding implementation and fairness. Despite staff reservations, we found that an AI-generated self-rostering system may be fairer than manual self-rostering, while saving radiology staff time and cost.

CONCLUSION

AI-generated self-rostering offers an innovative solution to an old problem. This self-rostering system provides a fair way for staff to have a say in the shifts they do, which increases feelings of work-life balance and autonomy. In this simulation, AI-generated self-rostering was well received, and most staff were receptive to moving to pilot the programme.

IMPLICATIONS FOR PRACTICE

Self-rostering could be a potential solution to staff retention issues in radiology; we recommend a pilot study is implemented. When switching to self-rostering, departments should consider implementing one-on-one support systems to assist staff with entering preferences. Education is essential to encourage staff understanding and cooperation.

Implementation of regulatory guidance for JAK inhibitors use in patients with immune-mediated inflammatory diseases: An international appropriateness study

BACKGROUND AND AIMS

The Pharmacovigilance Risk Assessment Committee (PRAC) proposed measures to address severe side effects linked to Janus kinase inhibitors (JAKi) in immune-mediated inflammatory diseases (IMID). Use of these medications in individuals aged 65 and older, those at high cardiovascular risk, active or former long-term smokers, and those with increased cancer risk should be considered only if no alternatives exist. Caution is advised when administering JAKi to patients at risk of venous thromboembolism. We aim to implement recommendations from regulatory guidelines based on areas of uncertainty identified.

METHODS

A two-round modified Research and Development/University of California Los Angeles appropriateness methodology study was conducted. A panel of 21 gastroenterologists, dermatologists and rheumatologists used a 9-point Likert scale to rate the appropriateness of administering a JAKi for each proposed clinical scenario. Scores for appropriateness were categorized as appropriate, uncertain, or inappropriate. Two rounds were performed, each with online surveys and a virtual meeting to enable discussion and rating of each best practice.

RESULTS

Round 1 involved participants rating JAKi appropriateness and suggesting descriptors to reduce uncertainty. Survey results were discussed in a virtual meeting, identifying areas of disagreement. In round 2, participants rated their agreement with descriptors from round 1, and the level of uncertainty and disagreement reduced. Age flexibility is recommended in the absence of other risk factors. Active counseling on modifiable risks (e.g., overweight, mild hyperlipidemia and hypertension) and smoking cessation is advised. Uncertainty persists regarding cancer risk due to various factors.

CONCLUSIONS

We outlined regulatory guidance without a personalized evaluation of the patient's risk profile might lead to uncertainty and become an arid technicality. Therefore, we identified gaps and implemented PRAC recommendations to help health professionals in clinical practice.

Ambiguous Encounters: Young women's expectations and experiences with intoxicated sexual relations in Danish nightlife

This article is based on 28 in-depth interviews with young women (18–25) about their experiences with intoxicated sexual encounters in Danish nightlife. Little research has examined the role intoxication plays in the processes of consensual and non-consensual sex. Using theories of intoxication and sexual scripts, this article focuses on how alcohol is used and perceived by these young women as a potential way of modifying behaviours and norms in their sexual encounters; how they characterize sexual consent and how they navigate intoxicated behaviour that can result in inappropriate, transgressive or victimizing situations. While the women talk about pleasurable and regrettable experiences, many described situations took on a much more ambiguous, fluid and nuanced role. The study points to the lack of knowledge on how ambiguity may play an active role in managing processes of sexual consent in intoxicated settings, especially for the youngest age groups.

Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation

Background

Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.

Methods

This is a subgroup analysis of the German Stroke Registry—Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days.

Results

Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high.

Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3–10.5] vs 7 [4–11], p = 0.73, mRS 4 [IQR 3–4] vs. 4 [IQR 3–5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02).

Conclusions

In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC.

Registration: https://www.clinicaltrials.gov; Unique identifier: NCT03356392.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42466-022-00207-7.

OP0117 REAL-WORLD EFFECTIVENESS OF TNFI VERSUS NON-TNFI BIOLOGICS ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE ACR’S RISE REGISTRY

Background:

Our understanding of how medications such as biologic disease modifying anti-rheumatic drugs and targeted small molecules (b/tsDMARDs) influence disease activity in RA is based largely on randomized controlled trials (RCTs). However, most U.S. trials in RA are limited by small sample sizes and have often excluded patients who are older, male, and from racial/ethnic minorities. Whether effectiveness of b/tsDMARDs varies in these populations has largely been unexplored.

Objectives:

We aimed to examine differences in longitudinal RA disease activity by demographic and clinical characteristics using a novel electronic health record data source of rheumatology providers across the U.S. We simulated various treatment assignments of b/tsDMARDs that have been examined in RCTs: namely, TNF-inhibitors (TNFi) and non-TNFi.

Methods:

We included 16,448 individuals from the ACR’s RISE registry with ≥ 2 RA diagnoses (ICD-9: 714.0) ≥ 30 days apart, who had at least 2 recorded clinical disease activity index (CDAI) scores and no historical b/tsDMARD use documented in RISE. b/tsDMARD use and CDAI scores were assessed at each quarter; covariates included sex, race (white, Black, Asian, other), ethnicity (Hispanic/non-Hispanic), age, smoking, obesity, area deprivation index, other DMARD use, RF status, anti-CCP status, and practice type. Longitudinal targeted maximum likelihood estimation estimated the average treatment effect (ATE) of cumulative TNFi vs. non-TNFi use over a 12-month period on CDAI score among the entire population and across various subgroups based on demographic and clinical characteristics, accounting for censoring and time-varying confounding.

Results:

Approximately 75% of patients were female with a mean age of 65.1 (+/- 13.7) years. Sixty percent of patients were white, 8% black, 2% Asian, and 30% other/mixed or unknown race; 6% were Hispanic. The mean CDAI score at baseline was 11.3 (+/- 10.7). For the overall population, there was no significant difference in disease activity between TNFi and non-TNFi at 12 months (ATE= 0.85, 95% CI -0.26, 1.96; Table 1). Stratified analyses found higher disease activity for TNFi compared to non-TNFi among patients of Black and Asian race, non-Hispanic ethnicity, and female sex. Among Black race patients, TNFi use was associated with a 6.08 point higher CDAI score compared to non-TNFi use (95% CI 1.99, 10.17). In contrast, in Hispanic/Latino ethnicity patients, TNFi use was associated with a lower CDAI score compared to non-TNFi use (ATE= -2.64, 95% CI -3.99, -1.30).

Table 1.

Average treatment effect (ATE) of cumulative TNFi vs. non-TNFi use at 12-months on CDAI score in patients with RA

TNFiNon-TNFiATE (95% CI)Overall (n=16,448)8.847.990.85 (-0.26, 1.96)Race White (n=9,814)8.246.811.42 (0.03, 2.81)* Black (n=1,358)13.917.836.08 (1.99, 10.17)* Asian (n=301)6.542.743.80 (2.93, 4.67)*Ethnicity Non-Hispanic (n=14,216)8.927.631.29 (0.08, 2.51)* Hispanic (n=938)5.698.33-2.64 (-3.99, -1.30)*Sex Female (n=12,527)8.987.471.51 (0.31, 2.72)* Male (n=3,921)8.579.49-0.92 (-3.42, 1.58)

*P<0.05

Conclusion:

Results from this RCT simulation study suggest that non-TNFi may have an important role as first-line agents in the treatment of Black and Asian patients, but not Hispanic patients. These novel findings fill gaps where RCTs have not been conducted, highlight the need for inclusion of diverse populations in future trials, and have the potential to lead to a more personalized approach to rheumatologic care.

References:

Disclosure of Interests:

Milena Gianfrancesco: None declared, Jing Li: None declared, Michael Evans: None declared, Maya Petersen: None declared, Gabriela Schmajuk: None declared, Jinoos Yazdany Consultant of: Eli Lilly and Astra Zeneca, unrelated to this project., Grant/research support from: Gilead, unrelated to this project.

[Telemedicine in stroke-pertinent to stroke care in Germany]

BACKGROUND AND OBJECTIVE

Telemedical stroke networks improve stroke care and provide access to time-dependent acute stroke treatment in predominantly rural regions. The aim is a presentation of data on its utility and regional distribution.

METHODS

The working group on telemedical stroke care of the German Stroke Society performed a survey study among all telestroke networks.

RESULTS

Currently, 22 telemedical stroke networks including 43 centers (per network: median 1.5, interquartile range, IQR, 1-3) as well as 225 cooperating hospitals (per network: median 9, IQR 4-17) operate in Germany and contribute to acute stroke care delivery to 48 million people. In 2018, 38,211 teleconsultations (per network: median 1340, IQR 319-2758) were performed. The thrombolysis rate was 14.1% (95% confidence interval 13.6-14.7%) and transfer for thrombectomy was initiated in 7.9% (95% confidence interval 7.5-8.4%) of ischemic stroke patients. Financial reimbursement differs regionally with compensation for telemedical stroke care in only three federal states.

CONCLUSION

Telemedical stroke care is utilized in about 1 out of 10 stroke patients in Germany. Telemedical stroke networks achieve similar rates of thrombolysis and transfer for thrombectomy compared with neurological stroke units and contribute to stroke care in rural regions. Standardization of network structures, financial assurance and uniform quality measurements may further strengthen the importance of telestroke networks in the future.

In vivo fluorescence molecular tomography of induced haemarthrosis in haemophilic mice: link between bleeding characteristics and development of bone pathology

Background

Haemophilic arthropathy is a chronic and debilitating joint disease caused by recurrent spontaneous joint bleeds in patients with haemophilia. Understanding how characteristics of individual joint bleeds relate to the subsequent development of arthropathy could improve management and prevention of this joint disease. Here, we aimed to explore relations between joint bleed characteristics and development of bone pathology in a mouse model of haemophilic arthropathy by using novel in vivo imaging methodology.

Methods

We characterised induced knee bleeds in a murine model of haemophilic arthropathy by quantitative in vivo fluorescence molecular tomography (FMT) and by measurements of changes in the diameter of the injured knee. Wild-type mice and non-injured haemophilic mice acted as controls. Development of arthropathy was characterised by post mortem evaluation of bone pathology by micro-CT 14 days after bleed-induction. In an in vitro study, we assessed the effect of blood on the quantification of fluorescent signal with FMT.

Results

In most injured haemophilic mice, we observed significant loss of trabecular bone, and half of the mice developed pathological bone remodelling. Development of pathological bone remodelling was associated with significantly increased fluorescent signal and diameter of the injured knee just 1 day after induction of the bleed. Further, a correlation between the fluorescent signal 1 day after induction of the bleed and loss of trabecular bone reached borderline significance. In the in vitro study, we found that high concentrations of blood significantly decreased the fluorescent signal.

Conclusion

Our results add novel insights on the pathogenesis of haemophilic arthropathy and underline the importance of the acute phase of joint bleeds for the subsequent development of arthropathy.

Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke

Background and Purpose—

Stroke etiology drives thrombus composition. We thus hypothesized that endovascular treatment shows different efficacy in cardioembolic versus noncardioembolic large-vessel occlusions (LVOs).

Methods—

Procedural characteristics, grade of reperfusion, and functional outcome at discharge and 90 days were compared between patients with cardioembolic versus noncardioembolic LVO from the GSR-ET (German Stroke Registry–Endovascular Treatment; n=2589). To determine associations with functional outcome, adjusted odds ratios and 95% CIs were calculated using ordinal multivariable logistic regression models adjusting for potential baseline confounder variables.

Results—

Endovascular treatment of cardioembolic LVO had a higher rate of successful reperfusion (85.6% versus 81.0%; P =0.002) and a higher rate of complete reperfusion after a single thrombectomy pass (45.7% versus 38.1%; P <0.001) compared with noncardioembolic LVO. Cardioembolic LVO was associated with better functional outcome at discharge (adjusted odds ratio, 1.61 [95% CI, 1.37–1.88]) and 90 days (adjusted odds ratio, 1.29 [95% CI, 1.09–1.53]). In mediation analysis, reperfusion explained 47% of the effect of etiology on functional outcome at discharge.

Conclusions—

These results provide evidence for higher efficacy of endovascular treatment in cardioembolic LVO compared with noncardioembolic LVO.

Routine Analysis of Proteins by Kjeldahl and Dumas Methods: Review and Interlaboratory Study Using Dairy Products

The Kjeldahl and Dumas (combustion) methods were compared in 11 laboratories analyzing samples of milk, skim milk powder, whole milk powder, whey protein concentrate, infant formula, casein, caseinate, 2 reference compounds (glycine and EDTA), and a secondary reference skim milk powder. The comparison was conducted by using international standards where applicable. Overall means were 8.818 g N/100 g by the Kjeldahl method and 8.810 g N/100 g by the Dumas method. No evidence was found for a consistent bias between methods that may be of concern in the trading of dairy produce. A review of more than 10 related trials revealed a lack of consensus in the bias between the 2 methods, suggesting that differences in methodology and sources of systematic error may be contributors. For samples containing &gt;2 g N/100 g, the Dumas relative repeatability and reproducibility standard deviations were consistently about 0.35 and 0.75%, respectively, whereas the corresponding Kjeldahl values declined generally with N content and were significantly larger. The Dumas precision characteristics may be due to the dominance of Leco analyzers in this trials, and in most other recent trials, rather than an inherent method attribute. Protein determination methods for dairy products need to be reviewed and updated. The Dumas method needs Codex Alimentarius status as a recognized test method.