Assessing the productivity of PAs and NPs.

The improvement of healthcare efficiency and productivity is of international interest. Following an expansion phase of physician associate/assistant (PA) and NPs employment, the Department of Veterans Affairs (VA) assessed how and where they were being used. Using data from 134 VA medical centers, annual productivity was examined across 30 medical and surgical specialties spanning primary care, mental health, and surgery.

The Effect of Telehealth Services on Provider Productivity.

Background: Telehealth services historically have played a small role in the provision of health care in the United States. However during the coronavirus disease 2019 (COVID-19) pandemic, public and private insurers rapidly expanded access to telehealth in order to reduce exposure and avoid transmission. It is unknown whether telehealth will become a more regular substitute for in-person care beyond the pandemic.

COVID-19 and cardiac arrhythmias: a global perspective on arrhythmia characteristics and management strategies.

Background: Cardiovascular and arrhythmic events have been reported in hospitalized COVID-19 patients. However, arrhythmia manifestations and treatment strategies used in these patients have not been well-described. We sought to better understand the cardiac arrhythmic manifestations and treatment strategies in hospitalized COVID-19 patients through a worldwide cross-sectional survey.

The gap between what patients know and desire to learn about their cardiac implantable electronic devices.

Background: Advancement of digital technology now allows patients to have access to data from their cardiac implantable electronic devices (CIEDs). However, patients' understanding regarding CIED data and perceived personal usability remain unclear. The present study is a prospective survey to examine patients' understanding of their CIEDs and their perception of what is important.

Safety of Oral Dofetilide Reloading for Treatment of Atrial Arrhythmias.

Background: Although dofetilide labeling states that the drug must be initiated or reinitiated with continuous electrocardiographic monitoring and in the presence of trained personnel, the risks of dofetilide reloading justifying repeat hospitalization have not been investigated.

Methods And Results: Patients admitted for dofetilide reloading for atrial arrhythmias were retrospectively reviewed. The need for dose adjustment and the incidence of torsades de pointes (TdP) were identified.

Cardiac Troponin Measurement in the Critically Ill: Potential for Guiding Clinical Management.

Background: Elevated cardiac troponin (cTn) in the absence of acute coronary syndromes (ACS) is associated with increased mortality in critically ill patients. There are no evidence-based interventions that reduce mortality in this group.

Objectives: We performed a retrospective investigation of the Veterans Administration Inpatient Evaluation Center database to determine whether drugs used in ACS (β-blockers, aspirin, and statins) are associated with reduced mortality in critically ill patients.

Safety of oral dofetilide for rhythm control of atrial fibrillation and atrial flutter.

Background: Although dofetilide is widely used in the United States for rhythm control of atrial fibrillation, there is limited postapproval safety data in the atrial fibrillation population despite its known risk of Torsade de pointes (TdP).

Methods And Results: We conducted a retrospective chart review of a cohort of 1404 patients initially loaded on dofetilide for atrial fibrillation suppression at the Cleveland Clinic from 2008 to 2012 to evaluate the incidence and risk factors for in-hospital adverse events and the long-term safety of continued use. Of the 17 patients with TdP during loading (1.

Capsule endoscopy in examination of esophagus for lesions after radiofrequency catheter ablation: a potential tool to select patients with increased risk of complications.

Background: Esophageal injury can result from left atrial radiofrequency ablation (RFA) therapy, with added concern because of its possible relationship to the development of atrial-esophageal (A-E) fistulas.

Objective: Evaluate utility of esophageal capsule endoscopy to detect esophageal lesions as a complication of RFA therapy in the treatment of atrial fibrillation (AF).

Methods: Consecutive patients with AF who underwent left atrial RFA therapy and received capsule endoscopy within 48 hours postablation.

Upper airway volume segmentation analysis using cine MRI findings in children with tracheostomy tubes.

Objective: The purpose of this study is to evaluate the airway dynamics of the upper airway as depicted on cine MRI in children with tracheotomy tubes during two states of airflow through the upper airway.

Materials And Methods: Sagittal fast gradient echo cine MR images of the supra-glottic airway were obtained with a 1.5T MRI scanner on seven children with tracheotomy tubes.

Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls.

Background: Cine MRI has become a useful tool in the evaluation of patients with persistent obstructive sleep apnea (OSA) despite previous surgical intervention and in patients with underlying conditions that render them susceptible to multilevel airway obstruction. Findings on cine MRI studies have also increased our understanding of the mechanisms and anatomic causes of OSA in children.

Objective: To compare lingual tonsil size between children with OSA and a group of normal controls.

Obstructive sleep apnea: MR imaging volume segmentation analysis.

Purpose: To retrospectively determine airway wall motion with volume segmentation of transverse cine magnetic resonance (MR) images in children with obstructive sleep apnea (OSA).

Materials And Methods: Transverse fast gradient-echo cine MR images of the hypopharynx were obtained at 1.5 T in 31 children with OSA (eight girls, 23 boys; mean age, 11.

Oral contrast agents for CT of abdominal trauma in pediatric patients: a comparison of dilute hypaque and water.

Objective: Dilute Hypaque Sodium is generally well accepted as an oral contrast agent for CT of pediatric patients who have experienced recent blunt abdominal trauma. However, Hypaque can cause complications. Using water as a substitute contrast agent eliminates these potential complications.

Trial of metronidazole vs. azithromycin for treatment of cyclosporine-induced gingival overgrowth.

Gingival overgrowth usually characterized by increased cellular growth of gingival fibroblasts appears to be multifactorial. In patients receiving CyA for more than 3 months, the incidence can approach 70% and can be attributed to pharmaceutical immunosuppression. Case reports have reported regression of overgrowth with both metronidazole and azithromycin.

Diagnostic errors by radiology residents in interpreting pediatric radiographs in an emergency setting.

Background: There are few data regarding the frequency and type of diagnostic errors made by radiology residents and fellows ("trainees"). However, increasing interest in reducing medical errors highlights the need to analyze which areas of medical knowledge are most problematic for physicians-in-training, including radiology trainees. Once these areas are identified, they can be emphasized during training.

Incidence and severity of vesicoureteral reflux in children related to age, gender, race and diagnosis.

Purpose: We determine if the incidence and grade of vesicoureteral reflux (VUR) differs in children based on age, race and gender, and if the incidence and severity of VUR are related to race in girls younger than 7 years presenting for evaluation after urinary tract infection (UTI).

Materials And Methods: The records of all children who underwent a voiding cystourethrogram or radionuclide cystogram between 1993 and 2001 were retrospectively reviewed. Age, gender, race, clinical indication and highest grade of VUR were recorded for the first voiding cystourethrogram or radionuclide cystogram.

Using a phantom to compare MR techniques for determining the ratio of intraabdominal to subcutaneous adipose tissue.

Objective: Patients who have a greater distribution of intraabdominal adipose tissue as compared with subcutaneous adipose tissue and an increased ratio of intraabdominal adipose tissue to subcutaneous adipose tissue are at greater risk for developing cardiovascular disease and type 2 diabetes mellitus. In previous MR investigations, researchers have used conventional T1-weighted spin-echo images to determine the ratio of intraabdominal adipose tissue to subcutaneous adipose tissue. However, no investigation, to our knowledge, has been performed to determine the accuracy of using different MR sequences to estimate adipose distribution.

Upper airway motion depicted at cine MR imaging performed during sleep: comparison between young Patients with and those without obstructive sleep apnea.

Purpose: To compare the patterns of dynamic airway motion depicted on cine magnetic resonance (MR) images obtained during sleep between young patients with and those without obstructive sleep apnea (OSA).

Materials And Methods: Fast gradient-echo sequences were performed in the sagittal midline by using a 1.5-T unit to create cine MR images.

In-plane bismuth breast shields for pediatric CT: effects on radiation dose and image quality using experimental and clinical data.

Objective: The purpose of our study was to evaluate the amount of radiation dose reduction and its effect on image quality when using an in-plane bismuth breast shield for multidetector CT (MDCT) of the chest and abdomen in female pediatric patients.

Subjects And Methods: Fifty consecutive MDCT examinations (chest, 29; abdomen, 21) of female pediatric patients (mean age, 9 years; range, 2 months-18 years) were performed with a 2-ply (1.7 g of bismuth per square centimeter) bismuth shield (three sizes to accommodate patients of varying sizes) overlying the patient's breasts.

Low-tube-current multidetector CT for children with suspected extrinsic airway compression.

Objective: The purpose of our study was to review the technical success achieved using low-tube-current multidetector CT for the evaluation of children with suspected extrinsic airway compression and to evaluate the need for sedation during this procedure.

Materials And Methods: We reviewed all CT examinations performed for the evaluation of extrinsic airway compression during the first year after installation of a multidetector CT scanner at a pediatric hospital. We recorded the technical parameters including tube current, kilovoltage, slice thickness, mode of study, sedation technique, and amount of contrast material and noted which postprocessing techniques were applied.

Venous pressure monitoring does not accurately predict access failure in children.

Access failure is a significant cause of morbidity and mortality in hemodialysis patients. Routine monitoring of arteriovenous (AV) fistulas and grafts could increase access longevity. Dynamic venous pressure monitoring is a surveillance test advocated to detect early signs of vascular thrombosis.

"Missing" sternal ossification center: potential mimicker of disease in young children.

Purpose: To evaluate the frequency of "missing" sternal ossification center (asynchronous non-ossification) in young children.

Materials And Methods: Lateral chest radiographs obtained in 229 children (mean age, 3.7 years) were retrospectively evaluated for sternal ossification.