Left Ventricular Dimensions and Clinical Outcomes With a Fully Magnetically Levitated Left Ventricular Assist Device.

Background: Prior analyses have suggested that a smaller left ventricular end-diastolic diameter (LVEDD) is associated with reduced survival following HeartMate 3 left ventricular assist device implantation.

Objectives: In this trial-based comprehensive analysis, the authors sought to examine clinical characteristics and association with the outcome of this specific relationship.

Methods: The authors analyzed the presence of LVEDD <55 mm among 1,921 analyzable HeartMate 3 patients within the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) trial portfolio, on endpoints of overall survival and adverse events at 2 years.

Improving Antimicrobial Utilization and Infection Control in Ophthalmology: An Information-Assisted Transparent Supervision and Multidisciplinary Team Model.

Background: Using antimicrobials wisely is crucial for effective treatment and reducing antimicrobial resistance (AMR). As ocular infections can lead to serious consequences and ophthalmic surgery has a great impact on patients, the application of antimicrobials in ophthalmology needs to be managed in a standardized manner.

Methods: A multidisciplinary team (MDT) on antimicrobial stewardship was set up by adopting comprehensive management measures and a continuous improvement model with all-staff training and empowerment, information-assisted medical prescription control, and transparent supervision.

A pedigree with retinitis pigmentosa and its concomitant ophthalmic diseases.

Aim: To characterize the ophthalmic clinical phenotype of a family with retinitis pigmentosa (RP) and closed-angle glaucoma and to detect pathogenic genes and mutation sites causing RP in this family.

Methods: Ophthalmic clinic performance was examined in detail in 8 enrolled family members. Genomic DNA was extracted from the peripheral blood of 4 family members for whole-exome sequencing (WES) to select potential genetic mutations whose structures were identified by bioinformatics analysis.

Fully magnetically centrifugal left ventricular assist device and long-term outcomes: the ELEVATE registry.

Background And Aims: HeartMate 3 (HM3) is a fully magnetically levitated continuous flow left ventricular assist device, which received CE marking in 2015. The ELEVATE Registry was initiated to collect real-world outcomes in patients treated with HM3 post-CE Mark approval.

Methods: A total of 540 subjects implanted at 26 centres between March 2015 and February 2017 were included in this registry.

Annexin A1 in the nervous and ocular systems.

The therapeutic potential of Annexin A1, an important member of the Annexin superfamily, has become evident in results of experiments with multiple human systems and animal models. The anti-inflammatory and pro-resolving effects of Annexin A1 are characteristic of pathologies involving the nervous system. In this review, we initially describe the expression sites of Annexin A1, then outline the mechanisms by which Annexin A1 maintains the neurological homeostasis through either formyl peptide receptor 2 or other molecular approaches; and, finally, we discuss the neuroregenerative potential qualities of Annexin A1.

Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device.

Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD), it is unknown how preimplant factors and postimplant index hospitalization events influence 5-year mortality in those able to be discharged.

Objectives: The goal was to identify risk predictors of mortality through 5 years among HM3 LVAD recipients conditional on discharge from index hospitalization in the MOMENTUM 3 pivotal trial.

Methods: This analysis evaluated 485 of 515 (94%) patients discharged after implantation of the HM3 LVAD.

Incidence and clinical correlates of de-novo aortic regurgitation with a fully magnetically levitated left ventricular assist device: a MOMENTUM 3 trial portfolio analysis.

Aims: We assessed the incidence, predictors and clinical correlates of de-novo aortic regurgitation (AR), which physiologically reduces left ventricular assist device (LVAD) effectiveness due to recirculation syndrome, in the MOMENTUM 3 trial portfolio of the fully magnetically levitated HeartMate 3 (HM3) pump using the randomized pivotal trial (PT) and post-trial continued access protocol (CAP).

Methods And Results: De-novo aortic regurgitation incidence at 2 years was analysed in the randomized PT and validated in the first 1000 implanted patients of the CAP. Patients with concomitant/prior aortic valve surgery or without baseline or post-implant echocardiograms were excluded from this analysis.

Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial.

Importance: Although durable left ventricular assist device (LVAD) therapy has emerged as an important treatment option for patients with advanced heart failure refractory to pharmacological support, outcomes, including survival, beyond 2 years remain poorly characterized.

Objective: To report the composite end point of survival to transplant, recovery, or LVAD support free of debilitating stroke (Modified Rankin Scale score >3) or reoperation to replace the pump 5 years after the implant in participants who received the fully magnetically levitated centrifugal-flow HeartMate 3 or axial-flow HeartMate II LVAD in the MOMENTUM 3 randomized trial and were still receiving LVAD therapy at the 2-year follow-up.

Design, Setting, And Participants: This observational study was a 5-year follow-up of the MOMENTUM 3 trial, conducted in 69 US centers, that demonstrated superiority of the centrifugal-flow LVAD to the axial-flow pump with respect to survival to transplant, recovery, or LVAD support free of debilitating stroke or reoperation to replace the pump at 2 years.

Center Variability in Patient Outcomes Following HeartMate 3 Implantation: An Analysis of the MOMENTUM 3 Trial.

Background: As left ventricular assist device (LVAD) survival rates continue to improve, evaluating site-specific variability in outcomes can facilitate identifying targets for quality-improvement initiative opportunities in the field.

Methods: Deidentified center-specific outcomes were analyzed for HeartMate 3 (HM3) patients enrolled in the MOMENTUM 3 pivotal and continued access protocol trials. Centers < 25th percentile for HM3 volumes were excluded.

Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring.

Aims: Control of pulmonary pressures monitored remotely reduced heart failure hospitalizations mainly by lowering filling pressures through the use of loop diuretics. Sacubitril/valsartan improves heart failure outcomes and increases the kidney sensitivity for diuretics. We explored whether sacubitril/valsartan is associated with less utilization of loop diuretics in patients guided with haemodynamic monitoring in the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF).

Evaluation of environmental cleaning quality: an observational study at a tertiary hospital in Wuhan, China.

Introduction: The COVID-19 pandemic highlights the role of environmental cleaning in controlling infection transmission in hospitals. However, cleaning practice remains inadequate. An important component of effective cleaning is to obtain feedback on actual cleaning practice.

Factors Associated With Optimal Follow-up in Women With BI-RADS 3 Breast Findings.

Objective: Assess rate of and factors associated with optimal follow-up in patients with BI-RADS 3 breast findings.

Methods: This Institutional Review Board-approved, retrospective cohort study, performed at an academic medical center, included all women undergoing breast imaging (ultrasound and mammography) in 2016. Index reports for unique patients with an assessment of BI-RADS 3 (retrieved via natural language processing) comprised the study population.

Comparing Tumor Characteristics and Rates of Breast Cancers Detected by Screening Digital Breast Tomosynthesis and Full-Field Digital Mammography.

The purpose of this study was to compare the cancer detection rates (CDRs), tumor types, and characteristics between screening digital breast tomosynthesis (DBT) and screening full-field digital mammography (FFDM) in a matched patient population in a large academic breast imaging practice with mixed DBT and FFDM technology. In this retrospective study, we reviewed consecutive screening FFDM and DBT examinations performed between October 2012 and September 2014. To control for nonrandomized selection of FFDM versus DBT examinations, we applied propensity score matching on the basis of patient age, imaging site, and prior imaging findings.

Comparing Artificial Intelligence Approaches to Retrieve Clinical Reports Documenting Implantable Devices Posing MRI Safety Risks.

Objective: Assess sensitivity, specificity, and accuracy of two approaches to identify patients with implantable devices that pose safety risks for MRI-an expert-derived approach and an ontology-derived natural language processing (NLP). Determine the proportion of clinical data that identify these implantable devices.

Methods: This Institutional Review Board-approved retrospective study was performed at a 793-bed academic hospital.

Conspicuity of Screen-Detected Malignancies on Full Field Digital Mammography vs. Synthetic Mammography.

Rationale And Objectives: To evaluate conspicuity of screen-detected cancers on two-dimensional synthetic mammography (SM) reconstructed from digital breast tomosynthesis (DBT) compared to two-dimensional full field digital mammography (FFDM).

Materials And Methods: IRB-approved retrospective review of consecutive screen-detected cancers from October 1, 2015 to June 30, 2017 was performed. All examinations were reviewed by three radiologists in consensus (n = 224); a score of 1-3 was given to each screen-detected cancer on SM vs.

Impact of an Information Technology-Enabled Quality Improvement Initiative on Timeliness of Patient Contact and Scheduling of Screening Mammography Recall.

The purpose of this study was to evaluate the impact of an information technology-enabled quality improvement initiative on timeliness of patient contact and scheduling of screening mammography recall. The study was conducted in a screening practice (two ambulatory centers, A and B; two hospitals, C and D) that uses offline batch results (A, B, C) and same-day results (D) with on-site (A, C, D) or off-site (B) coordinators scheduling recalls. Before the intervention, radiologists at sites A, B, and C conveyed recalls via paper lists to coordinators after batch interpretation.

Impact of a Multifaceted Information Technology-Enabled Intervention on the Adoption of ACR White Paper Follow-Up Recommendations for Incidental Adnexal Lesions Detected on CT.

The objective of our study was to improve adherence to American College of Radiology (ACR) white paper follow-up imaging recommendations for incidental adnexal lesions seen on pelvic CT (herein referred to as "adherence rate to recommendations"). This quality improvement project was conducted at a large academic teaching hospital. The baseline adherence rate to recommendations was assessed by screening all pelvic CT reports for the period from October 22, 2016, through December 22, 2016, for incidental adnexal findings, followed by manual review.

Improving Patient Experience in Radiology: Impact of a Multifaceted Intervention on National Ranking.

Purpose To assess the impact of a patient experience improvement program on national ranking in patient experience in a large academic radiology department. Materials and Methods This Health Insurance Portability and Accountability Act-compliant study was exempted from institutional review board approval. After initiating an electronic patient experience survey, 26 210 surveys and 22 213 comments were received from May 2017 to April 2018.

Radiologist Preferences, Agreement, and Variability in Phrases Used to Convey Diagnostic Certainty in Radiology Reports.

Purpose: To understand radiologists' preference and variability in phrases for expressing diagnostic certainty in radiology reports.

Materials And Methods: This institutional review board-approved study was part of a quality improvement initiative to improve the quality of radiology reports at a tertiary academic hospital. Sixteen phrases commonly used in radiology reports to convey diagnostic certainty were extracted from prior publications.

Multivariate Analysis of Radiologists' Usage of Phrases that Convey Diagnostic Certainty.

Rationale And Objectives: To quantify the use of Diagnostic Certainty Phrases (DCP) in radiology reports, including DCPs with good agreement (including "diagnostic of," "unlikely" and "represents") in connoting degree of certainty between providers based on previous studies; and to assess whether modality, presence of a trainee, radiologic subspecialty, and individual radiologists are associated with the usage of DCPs with good agreement.

Materials And Methods: This retrospective, IRB-approved study was conducted at an academic medical center. Radiology reports that contain DCPs were identified using information retrieval from all reports generated in 2016, excluding mammograms, obstetrical ultrasound, bone densitometry, and interventional studies.

Integrity of clinical information in computerized order requisitions for diagnostic imaging.

Objective: Assess information integrity (concordance and completeness of documented exam indications from the electronic health record [EHR] imaging order requisition, compared to EHR provider notes), and assess potential impact of indication inaccuracies on exam planning and interpretation.

Methods: This retrospective study, approved by the Institutional Review Board, was conducted at a tertiary academic medical center. There were 139 MRI lumbar spine (LS-MRI) and 176 CT abdomen/pelvis orders performed 4/1/2016-5/31/2016 randomly selected and reviewed by 4 radiologists for concordance and completeness of relevant exam indications in order requisitions compared to provider notes, and potential impact of indication inaccuracies on exam planning and interpretation.

Quantifying and Characterizing Trainee Participation in a Major Academic Radiology Department.

Objective: Trainees play an important role in the delivery of medical services in academic medical centers, yet the full extent of their contribution in radiology is unknown. The purpose of this study was to quantify trainee involvement in a single large academic radiology department.

Materials And Methods: In this Institutional Review Board-approved retrospective study performed in a tertiary care academic medical center, we identified the proportion of radiology reports with trainee involvement (by means of report co-signature) between July 2015 and June 2016.

Assessing information sources to elucidate diagnostic process errors in radiologic imaging - a human factors framework.

Objective: To assess information sources that may elucidate errors related to radiologic diagnostic imaging, quantify the incidence of potential safety events from each source, and quantify the number of steps involved from diagnostic imaging chain and socio-technical factors.

Materials And Methods: This retrospective, Institutional Review Board-approved study was conducted at the ambulatory healthcare facilities associated with a large academic hospital. Five information sources were evaluated: an electronic safety reporting system (ESRS), alert notification for critical result (ANCR) system, picture archive and communication system (PACS)-based quality assurance (QA) tool, imaging peer-review system, and an imaging computerized physician order entry (CPOE) and scheduling system.

CT and MRI Protocol Variation and Optimization at an Academic Medical Center.

Purpose: To reduce CT and MRI protocol variation across a multisite radiology practice at an academic medical center so that patients with similar clinical presentations are examined the same way.

Materials And Methods: This study was performed at a large academic radiology practice performing ∼800,000 radiology examinations annually. To diminish variability across the enterprise (2 general radiology divisions; 10 subspecialty imaging divisions), a Harmonization Oversight Committee was created and tasked with ensuring patients with similar clinical presentations undergo the same CT or MRI protocol, regardless of where they are imaged.