Moving toward standardization: physician reporting of sleep studies

Detailed primary data collected from sleep studies should lead to specific and clear reports with evidence-based clinical recommendations that, when introduced by sleep medicine specialists, create a window of opportunity to support our non-sleep medicine referring teams and to engage patients and caregivers in their care as recipients of the reports. This is how sleep study reporting differs from other test reports; currently, there is wide variation in how the data collected are presented and summarized. The goal of this document is to offer recommendations for structured reporting of sleep studies. We offer a practical, complete, and relevant document and a structure that can be implemented across sleep centers nationwide and does not burden the interpreter. We anticipate some readers will opine that some of the content is beyond the scope of what the interpreter physician needs to include, while others will propose missing data that they feel should have been included. We feel that the flexibility of the proposal accommodates for this and allows for a "first step" toward standardization of physician reporting of sleep studies. High-quality structured reporting of sleep studies is becoming ever more important for patient care, benefiting patients, caregivers, clinicians, durable medical equipment companies, and payers.

CITATION

Lastra AC, Ingram D, Park J, et al. Moving toward standardization: physician reporting of sleep studies. J Clin Sleep Med. 2023;19(3):595-603.

A Change in the Trend of Quality Reporting in Leprosy Trials: A Systematic Review

BACKGROUND

Leprosy is a communicable disease caused by bacteria Mycobacterium Leprae. Despite all attempts, it has not been eradicated in several underdeveloped nations since the start of the antibiotic age. It's a social issue as well as a stigmatised disease. Due to these restrictions, randomised controlled trials in leprosy confront numerous obstacles, which are reflected in the quality of study reporting.

OBJECTIVES

The objective of this study is to use the Consolidated Standard for Reporting Trials (CONSORT) 2010 checklist to assess the quality of leprosy trial reporting.

METHODS

We assess the quality of reporting of randomised control trials on leprosy conducted after 2010 in the PubMed database, using the CONSORT checklist 2010. Second, we compare the quality of RCT reporting before and after the release of the CONSORT guidelines in 2010.

RESULTS

A total of 19 full-text eligible articles were examined and included in the final list of articles, which were then evaluated further. 4 out of 19 trials had a compliance percentage of more than 75%. 6 out of 19 trials had compliance percentage of 50% to 75%. 9 trials had a compliance percentage of below 50%. Highest compliance was 86.48% and the lowest compliance was 32.43%. When compared with trials before 2010, we could see an improvement in some criteria showing a statistically significant rise in comparison with trials conducted before 2010.

CONCLUSION

Leprosy is still a concern in developing countries, which have failed to eradicate the disease despite their best efforts and resources. The compliance of leprosy related RCTs has improved since the introduction of the CONSORT guidelines, but the quality of reporting still remains on the lower side.

After-hours radiology reporting in an Australian tertiary hospital: Factors influencing the rate of discrepancy for computed tomography reporting

INTRODUCTION

Demand for after-hours radiology services across Australia has been rapidly increasing for many years. Public hospital radiology departments are generally staffed by trainees after hours, often 1-2 doctors. This study reviewed 1 year of after-hours data at a tertiary hospital in Sydney, to determine overall discrepancy rates and factors which influenced the rate of discrepancy after hours. Overall radiology and after-hours case volumes are increasing, and the goal was to ensure that our department practices are within safe limits at current staffing levels.

METHODS

After-hours computed tomography scan reports issued by registrars were reviewed over 1 year between 01 January 2019 and 01 January 2020. Data recorded included overall case numbers on each shift, discrepancy rates and rates of clinically significant discrepancy. Caseload was measured by equivalent ascribed reporting time as described by Pitman et al. (2018).

RESULTS

There were 10,886 cases reported after hours during the study period and 1,412 discrepancies (13% cases). Of these, 300 (3.7%) were clinically significant. Factors that increased the rate of significant discrepancy included shifts with caseloads greater than 3 h of equivalent consultant reporting time per 8-h shift and the radiology trainee's level of training. The frequency of discrepancy for trauma cases was similar to non-trauma after adjusting for study type; however, the frequency of significant discrepancy was higher.

CONCLUSION

In all instances, the rates of discrepancy and clinically significant discrepancy remained well within ranges previously described.

Messages from the Seventh International Conference on Clinical Metagenomics (ICCMg7)

Clinical metagenomics (CMg), referring to the application of metagenomic sequencing of clinical samples to obtain clinically relevant information for the diagnosis and management of infectious diseases, has been rapidly evolving these last years. Following this trend, we held the seventh International Conference on Clinical Metagenomics (ICCMg7) in Geneva in October 2022. During the two-day conference, cutting-edge advances and new discoveries using CMg were presented which we summarize in the present paper. During this ICCMg7, we kept on following the progresses achieved worldwide that cover reproducibility in CMg, the advent of new technologies applied to the field of infectious diseases, innovative research in the field of the gut microbiota, and finally the expansion of CMg in the fields of clinical epidemiology with surveillance studies on emerging and known pathogens, but also on antibiotic resistance genes, in the environment and in the animal reservoirs.

Subclavian steal syndrome associated with right aortic arch: A case report

The right aortic arch (RAA) is a rare congenital vascular variant disease. We reported a case of subclavian steal syndrome associated with RAA. The primary clinical symptoms were vertigo and ischemic symptoms of the left upper extremity. We diagnosed the condition using aortic computed tomography angiography and digital subtraction angiography. The patient underwent carotid-subclavian bypass surgery.

A Literature Review on How We Can Address Medical Laboratory Scientist Staffing Shortages

OBJECTIVE

Laboratories are facing a critical shortage of medical laboratory scientists (MLS) and medical laboratory technicians (MLT) to address an increasing demand for laboratory testing. Training program closures, fewer student applicants, and financial decisions have contributed to staffing shortages. Lack of visibility, low wages, and perceived lack of opportunities for upward career mobility contribute to challenges in recruiting and retaining qualified individuals and students who are unaware of laboratory medicine careers. Our goal was to review the literature to determine the current state and consequences of staffing shortages, and potential solutions to address these shortages.

METHODS

Medline/PubMed, PubMed Central, MeSH, Google Scholar, and Marshall Digital Scholar were used as resources.

DISCUSSION/CONCLUSIONS

A collaboration of stakeholders is needed to identify staffing challenges, barriers, and solutions and to increase visibility of laboratory professionals. Early recruitment is best started in the middle and high school educational process.

Conference Report: European Society for Medical Oncology Congress 2022

The European Society of Medical Oncology took place in Paris Convention Centre, Paris, France on 9th -13th September 2022 and was attended by more than 28,000 delegates, 23,000 of which were in person and 5000 online. This was the first on-site ESMO congress after the COVID-19 pandemic. This report focuses on a selection of talks delivered at the conference. There was a vast collection of interesting talks, nevertheless, I attended talks that focused on rare cancers.

Giant Malignant Phyllode Tumor: A Case Report

Phyllodes are an uncommon type of fibroepithelial neoplasm of the breast, which account for only 0.3 to 0.5% of all breast neoplasms. Management requires complete surgical excision with negative margins. Giant phyllode tumors portray a surgical challenge because complete surgical excision with negative margins is vital to reduce local recurrence and metastatic spread. Here, we report a case of giant malignant phyllode tumor, approached with wide local excision and negative margins were successfully achieved. The purpose behind this paper is to report the patient's clinical history, presentation, intra-operative and histopathological findings, accompanied by a literature review to determine the significance of this finding and the approach in management.

What parents want in an autism diagnostic report: An interview-based study of parents accessing a neurodevelopmental assessment service

Diagnostic reports are a key outcome of autism assessment services. However, there is limited evidence regarding what key stakeholders, including families, want to see in reports. In this project, 30 parents whose young person had recently received a diagnosis of autism from a Neurodevelopmental Assessment Service in the North East of England took part in a telephone-based interview to explore what they want from a report. Interviews were analysed using thematic analysis. Ten key recommendations for reports were identified. Parents indicated that they want a detailed, balanced, sensitively written report. They highlighted that reports needed to be accessible and clearly structured. In this respect, it might be helpful to include a parent-driven summary of key points at the top, clear signposting of the structure of the report, and a description of what happened in the assessment process. Parents also valued practical, personalised recommendations based on the young person's strengths and difficulties. Future research might explore perspectives on reports in families accessing other services, in other client groups (e.g., families of pre-schoolers diagnosed with autism), and with different stakeholders, including schools, referrers and autistic people.

Operationalization and Reporting Practices in Manuscripts Addressing Gender Differences in Biomedical Research: A Cross-Sectional Bibliographical Study

Historically, authors in the biomedical field have often conflated the terms sex and gender in their research significantly limiting the reproducibility of the reported results. In the present study, we investigated current reporting practices around gender in biomedical publications that claim the identification of "gender differences". Our systematic research identified 1117 articles for the year 2019. After random selection of 400 publications and application of inclusion criteria, 302 articles were included for analysis. Using a systematic evaluation grid, we assessed the provided methodological detail in the operationalization of gender and the provision of gender-related information throughout the manuscript. Of the 302 articles, 69 (23%) solely addressed biological sex. The remaining articles investigated gender, yet only 15 (6.5%) offered reproducible information about the operationalization of the gender dimension studied. Followingly, these manuscripts also provided more detailed gender-specific background, analyses and discussions compared to the ones not detailing the operationalization of gender. Overall, our study demonstrated persistent inadequacies in the conceptual understanding and methodological operationalization of gender in the biomedical field. Methodological rigor correlated with more nuanced and informative reporting, highlighting the need for appropriate training to increase output quality and reproducibility in the field.

Pleuropulmonary Ultrasound in Pediatrics: Proposal of a Reporting Model From the Academy of Thoracic Ultrasound

With the emergence of the Covid-19 pandemic, pleuropulmonary ultrasound has become a very common tool in clinical practice, even in the pediatric field. Therefore, the clinicians' need to speak a common ultrasound language becomes increasingly necessary. The Italian scientific society AdET (Academy of Thoracic Ultrasound) has been carrying out the study and dissemination of pulmonary ultrasound in medical practice in Italy for years. With this article, the pediatric AdET group wants to propose a report model of pediatric pulmonary ultrasound as a useful tool in daily clinical practice to interpret the images and reach a diagnostic conclusion, aiming to share a standardized approach that may also support the sharing of research findings.

Why Do School Staff Sometimes Fail to Report Potential Victimization Cases? A Mixed-methods Study

Schools are in a position to connect children and adolescents suspected of being victims of violence with an external source of support by making referrals to external agencies. However, several studies have identified obstacles that hinder early reporting among school staff members. Very few studies have applied a mixed-method approach to try to understand this sensitive issue. The current study used this approach to analyze to what extent the students suspected of being victimized match the ones reported by active school staff members in Spain (n = 453, 83.5% females, age: M = 42.23, SD = 9.46). We classified the reasons given for not reporting the potential victimization cases encountered and made comparisons to determine whether there were differences in the level of knowledge, or in the sociodemographic characteristics, of respondents who gave different reasons for not reporting. Although 73.5% of school staff members had detected at least one potential case, 40.8% of them referred it to an external agency. The most common reasons for lack of reporting included deciding not to do so once concerns had been shared within the school and believing that one must be certain or that only serious violence should be reported. The findings of this study may help to further understand the decisions not to report certain suspicions of potential victimization cases to external agencies by school staff. There is an urgent need to raise awareness about the duty to report these concerns to external agencies, even in the absence of agreement from the school management team. Members of school staff need to be strongly encouraged to become familiar with the existing protocols.

Pictorial essay on MRI local staging of rectal carcinoma: An easy approach

Rectal cancer is common and accounts for more than one-third of colorectal tumors. It is associated with significant morbidity and mortality. Previously computed tomography scan is the key imaging modality in preoperative assessment to detect local invasion and distant metastasis. However, the advent of magnetic resonance imaging (MRI) has aided in local staging and prognosticates the outcome of rectal tumor. Here, the author briefly explains why rectal MRI has a comprehensive role and provides a simple and easy way in reporting an MRI rectal carcinoma, even for a non-radiologist.

Case Report: Hematologic Recovery Following Stereotactic Ablative Radiotherapy in a Patient With Early-Stage Non-Small Cell Lung Cancer and Paraneoplastic Myelofibrosis

Herein, we report the first case presentation of paraneoplastic myelofibrosis associated with cancer. Paraneoplastic syndromes occur in some patients with thoracic malignancies; however, myelofibrosis is not commonly seen in non-small cell lung cancer (NSCLC). We report a case of myelofibrosis in a patient with a new diagnosis of NSCLC that resolved after stereotactic ablative radiotherapy (SABR). In conclusion, NSCLC may evoke unexpected systemic effects that resolve with treatment.

[The research activity of students in "The public health and health care, health care economics" discipline]

The article considers research work of students in "The Public health and health care, health economics" discipline in 2001-2020, organized in course of public health and health care of the Medical Institute of Petrozavodsk State University. The article reveals such concepts as student scientific activity, knowledge requirements for discipline to prepare student research work, classification of student research works by degree of collection and analysis of material, levels of student work performance, stages and classes of social hygienic research, requirements for content of presentation, criteria of evaluating report and presentation. During 2001-2021, 250 students of medical institute in the section "Public health and health care" made more than 200 reports, published more than 20 thesis and articles. The annual plan of 30 topics for student research works was developed, including requirements for content of presentation, 3 indices to evaluate quality of work. The text of presentation-report in 90% included information on one discipline "Public health and health care, health economics". At that, topic was disclosed in format of describing research objectives with construction of diagrams and graphs, comparison of indices and only 10% of reports contained statistical analysis of the results.

Mycobacterium fortuitum pacemaker infection: A case report

BACKGROUND

Mycobacterium fortuitum is a rapidly growing mycobacterium, ubiquitous in soil and water, but it is an uncommon cause of infections in immunocompetent hosts. Cardiac device infections and bloodstream infections due to non-tuberculous mycobacteria are rare.

CASE PRESENTATION

We present the case of an 85-year-old patient with infective endocarditis and pacemaker lead infection secondary to M. fortuitum.

Non-radiologist perception of the use of artificial intelligence (AI) in diagnostic medical imaging reports

INTRODUCTION

Incorporating artificial intelligence (AI) in diagnostic medical imaging reports has the potential to improve efficiency. Although perception of radiologists, radiographers, medical students and patients on AI use in image reporting has been explored, there is limited literature on non-radiologist clinicians' opinion on this topic.

METHOD

Single-centre online survey targeting non-radiologist medical staff conducted from May to August 2021 at a tertiary referral hospital in Melbourne, Australia. Survey questions revolved around clinicians' level of comfort acting on AI-generated reports with varying levels of radiologist involvement and scan complexity, opinion on medicolegal responsibility for erroneous AI-issued reports and perception of data privacy and security.

RESULTS

Eighty-eight responses were collected, including 47.9% of consultants. Non-radiologist clinicians across all seniorities and specialties felt significantly less comfortable acting on AI-issued reports compared with radiologist-issued reports (mean comfort radiologist 6.44/7, mean comfort AI 3.35/7, P < 0.001) but felt equally comfortable with an AI-hybrid model of care (mean comfort hybrid 6.38/7, P = 0.676). Non-radiologist clinicians believed that medicolegal responsibility with errors in AI-issued reports mostly lay with hospitals or health service providers (65.9%) and radiologists (54.5%). Regarding data privacy and security, non-radiologist clinicians felt significantly less comfortable with AI issuing image reports instead of radiologists (P < 0.001).

CONCLUSION

A hybrid AI-generated radiologist-confirmed method of image reporting may be the ideal way of integrating AI into clinical practice based on the perception of our referring non-radiologist medical colleagues. Formal guidelines on medicolegal responsibility and data privacy should be established prior to utilising AI in the clinical setting.

Case Report: A Novel Genetic Mutation Causes Idiopathic Infantile Arterial Calcification in Preterm Infants

Idiopathic infantile arterial calcification (IIAC), also known as generalized arterial calcification of infancy (GACI), is a heritable ectopic mineralization disorder that results in diffuse arterial calcifications and or stenosis, which are attributed to mutations in the ENPP1 gene. In this case study, we report the development of IIAC in a 2-month-old male preterm infant. The patient presented with severe hypertension and seizures, which revealed diffused calcifications and c.130C > T and c.1112A > T mutations in the ENPP1 gene. With biphosphonate, antihypertensive, and control epilepsy therapy, his blood pressure was maintained at 110–120/50–60 mmHg. Intellectual motor development retardation was anticipated in this patient. To the best of our knowledge, this is the first case in which a novel c.130C > T mutation in the ENPP1 gene has been identified, and the administration of bisphosphonates to patients with IIAC has been assessed.

Multicentre cohort study of cochlear implantation outcomes in Thailand

OBJECTIVES

To report the status and outcomes of cochlear implantation in Thailand.

DESIGN

Cohort study.

SETTING

Tertiary care and university hospitals.

PARTICIPANTS

Patients who underwent cochlear implant surgery in Thailand.

INTERVENTIONS

This project collected data from all government and university hospitals in Thailand where cochlear implant surgery was performed between 2016 and 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

Baseline characteristics, operation data, complications, audiological outcomes and quality of life were reported.

RESULTS

This study included 458 patients, and nearly half of the patients were children and adolescents (46.94%). The mean age of the patients was 2.96±5.83 years. At 1 year postoperatively, the mean pure tone average of the hearing threshold in the implanted ear significantly improved from unaided preoperative baseline (mean difference (MD) 64.23 dB HL; 95% CI 59.81 to 68.65; p<0.001). The mean speech recognition threshold also improved (MD 55.96 dB HL; 95% CI 49.50 to 62.42, p<0.001). The quality-of-life scores of the EQ-5D-5L, PedsQL and HUI3 questionnaires at 1 year showed improved mobility (range, 0-5; MD 0.65; 95% CI 0.05 to 1.25; p=0.037), hearing (range, 0-6; MD 0.96; 95% CI 0.30 to 1.61; p=0.006) and speech (range, 0-5; MD 0.44; 95% CI 0.04 to 0.84; p=0.031). Common complications included electrode dislodgement (2.18%), vertigo (1.23%) and meningitis (1.93%).

CONCLUSIONS

Excellent audiological outcomes and improvement in the quality of life in the mobility, hearing and speech domains were observed in patients who underwent cochlear implantation in Thailand.

Facial Nerve Palsy as a Neurological Manifestation of COVID-19

Facial nerve palsy is the most frequent acute mononeuropathy and it is often of viral etiology, although many other causes have been identified. It has recently been described as a potential manifestation of COVID-19. We report the case of a patient with recent history of diarrhea and malaise that was admitted to the hospital presenting right facial paresis with orbicular muscle involvement. Nasopharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the real-time reverse transcription polymerase chain reaction and magnetic resonance imaging showed no structural changes. During the hospital stay, the patient showed clinical improvement, and no other symptoms were observed. This case presentation suggests a possible association between neuropathies and SARS-CoV-2 infection.

Lessons learned about appendiceal neuroendocrine neoplasms from data analysis of the Belgian Cancer Registry 2010-2015

BACKGROUND AND STUDY AIMS

Appendiceal neuroendocrine neo-plasms (aNENs) are a diverse group of malignant neoplasms of varying biological behavior for which information about manage-ment and outcome is sparse, with the majority of available studies being retrospective, including only a limited number of patients, and therefore not necessarily reflecting the reality in the community. In the present study clinical, epidemiological and pathological data of appendiceal neuroendocrine neoplasms in Belgium is provided and compared with current literature.

METHODS

A population-based study was conducted by linking data of the Belgian Cancer Registry with medical procedures in the Belgian Health Insurance database for patients diagnosed with aNEN between 2010 and 2015.

RESULTS

We found an aNEN incidence of 0.97/100.000 person years in Belgium. Neuroendocrine carcinoma of the appendix are rare. Most appendiceal neuroendocrine tumors (aNETs) are small G1 tumors. Positive lymph nodes are often found in tumors larger than 2cm, especially aNET G2.

CONCLUSION

A rapid uptake of changing classifications was seen in the community. However, systematic reporting of risk factors for small aNEN can still be improved and should be stimulated. In 9% of cases, reclassifications had to be made, pointing out that in a retrospective analysis, original pathological reports should be checked for specific parameters, before reliable conclusions can be drawn.

Implementation of Machine Learning Software on the Radiology Worklist Decreases Scan View Delay for the Detection of Intracranial Hemorrhage on CT

BACKGROUND AND PURPOSE

Prompt identification of acute intracranial hemorrhage on CT is important. The goal of this study was to assess the impact of artificial intelligence software for prioritizing positive cases.

MATERIALS AND METHODS

Cases analyzed by Aidoc (Tel Aviv, Israel) software for triaging acute intracranial hemorrhage cases on non-contrast head CT were retrospectively reviewed. The scan view delay time was calculated as the difference between the time the study was completed on PACS and the time the study was first opened by a radiologist. The scan view delay was stratified by scan location, including emergency, inpatient, and outpatient. The scan view delay times for cases flagged as positive by the software were compared to those that were not flagged.

RESULTS

A total of 8723 scans were assessed by the software, including 6894 cases that were not flagged and 1829 cases that were flagged as positive. Although there was no statistically significant difference in the scan view time for emergency cases, there was a significantly lower scan view time for positive outpatient and inpatient cases flagged by the software versus negative cases, with a reduction of 604 min on average, 90% in the scan view delay (p-value < 0.0001) for outpatients, and a reduction of 38 min on average, and 10% in the scan view delay (p-value <= 0.01) for inpatients.

CONCLUSION

The use of artificial intelligence triage software for acute intracranial hemorrhage on head CT scans is associated with a significantly shorter scan view delay for cases flagged as positive than cases not flagged among outpatients and inpatients at an academic medical center.