Chapter 13 - Next-generation imaging in pathology

AB1343 Impact of a rheumatoid arthritis multi-biomarker disease activity test on clinical practice

To test the relationships between the geriatric practice environment, geriatric nursing practice, and overall quality of care for older adults and their families as reported by nurses working in hospitals, while controlling for nurse and hospital characteristics. A cross-sectional tailored survey design was employed. A questionnaire was mailed to a randomly selected sample of nurses whose primary practice area was medicine, surgery, geriatrics, emergency, or critical care in acute care hospitals in Ontario, Canada. Participants (N = 2,005) working in 148 hospitals responded to validated measures of the geriatric practice environment, geriatric nursing practice, overall quality of care for older adults and their families, and nurse and hospital characteristics. The relationships were tested using structural equation modeling. Controlling for nurse and hospital characteristics, the geriatric practice environment had a statistically significant positive relationship of large magnitude with both geriatric nursing practice (β = 0.52) and overall quality of care (β = 0.92); however, the indirect relationship between the geriatric practice environment and overall quality of care, mediated by geriatric nursing practice, was not significant (β = -0.02). Final model fit was acceptable, with the root mean square error of approximation = 0.07, comparative fit index = 0.93, and Tucker-Lewis Index = 0.87. A strong geriatric practice environment positively and directly influences geriatric nursing practice and overall quality of care for older adults and their families but does not appear to influence overall quality of care indirectly through geriatric nursing practice. The results can be used as the basis for promoting practice environments that support overall quality of care and geriatric nursing practice in acute care hospitals.

Older patients with multiple chronic conditions may be at higher risk of receiving poorer overall quality of care compared with those with single or no chronic conditions. Possible reasons include competing guidelines for individual conditions, burden of numerous recommendations, and difficulty implementing treatments for multiple conditions. We sought to determine whether coexisting combinations of 8 common chronic conditions (hypertension, coronary artery disease, chronic obstructive pulmonary disease, osteoarthritis, diabetes mellitus, depression, osteoporosis, and having atrial fibrillation or congestive heart failure) are associated with overall quality of care among vulnerable older patients. Using an observational cohort study, we enrolled 372 community-dwelling persons 65 years of age or older who were at increased risk for death or functional decline within 2 years. We included (1) a comprehensive measure (% of quality indicators satisfied) of quality of medical and geriatric care that accounted for patient preference and appropriateness in light of limited life expectancy and advanced dementia, and (2) a measure of multimorbidity, either as a simple count of conditions or as a combination of specific conditions. : Multimorbidity was associated with greater overall quality scores: mean proportion of quality indicators satisfied increased from 47% for elders with none of the prespecified conditions to 59% for those with 5 or 6 conditions (P < 0.0001), after controlling for number of office visits. Patients with greater multimorbidity also received care that was better than would be expected based on the specific set of quality indicators they triggered. Among older persons at increased risk of death or functional decline, multimorbidity results in better, rather than worse, quality of care.

PDG38 Association between Satisfaction with Quality of Care and ANTI-Dementia Medication Adherence Among Elderly Adults with Alzheimer's Disease and Related Dementias

To better understand the experiences and potential unmet need of persons who die in long-term care. We conducted after-death interviews with staff who had cared for 422 decedents with dementia and 159 who were cognitively intact and received terminal care in U.S. nursing homes (NHs) or residential care-assisted living (RC-AL) settings. We conducted family caregiver interviews for 293 decedents. We noted no differences between decedents with and without dementia in terms of pain, psychosocial status, family involvement, advance care planning, most life-prolonging interventions, and hospice use. Dying residents with dementia tended to die less often in a hospital, have less shortness of breath, receive more physical restraints and sedative medication, and use emergency services less frequently on the last day of life. Persons with dementia dying in RC-AL settings tended to have more skin ulcers and poorer hygiene care than nondemented persons in RC-AL settings. In comparison with persons dying with dementia in NHs, those in RC-AL settings tended to be restrained less often, have emergency services called more often on the day of death, and have family more satisfied with physician communication. These results suggest that the overall quality of care for persons dying with dementia in long-term-care settings may not differ markedly from that provided to persons who are cognitively intact. Similarly, large discrepancies in the overall quality of palliative care for persons with dementia in RC-AL facilities and NHs were not identified. However, numerous specific areas for care improvement were noted.

BackgroundTo determine how socioeconomic factors, such as level of education and employment status, affect patient experiences on quality of care for ambulatory healthcare services in teaching hospitals in southeast Nigeria.MethodsThe study is of a cross-sectional design and exit poll was used to collect its data. A pre-tested structured questionnaire was administered to clients accessing care in the outpatient departments of three tertiary hospitals in Nigeria. The assessment of patient experiences for quality of care was based on five (5) domains of care: waiting time; environment of the outpatient department; quality of doctor’s care; quality of care by nurses/other health workers; and responsiveness of care. In addition, the overall quality of care was assessed.ResultsThe mean rating of patient experience for quality of care for ambulatory healthcare services (outpatients’ care) was 74.31 ± 0.32%. Moderate differences were observed between the hospitals assessed for various levels of patients’ care, especially for waiting time, quality of doctors’ care and overall quality of care. Employment status was a statistically significant (p ≤ 0.05) determinant of overall patient experience rating for quality of care, while the level of patient’s education was an influence on the perception of waiting by the patients and their rating of care from nurses/other healthcare providers (apart from medical doctors).ConclusionThe study showed that educational and employment status (measures of socioeconomic status) of patients determined how patients receiving ambulatory (outpatient) healthcare services perceived the quality of care in the hospitals. Hence, in order to ensure equity, there is need to institutionalize patient-centered care, while full consideration is given to the patients’ socioeconomic status.

In CT scanning, image quality has many components and is influenced by many technical parameters. While image quality has always been a concern for the physics community, clinically acceptable image quality has become even more of an issue as strategies to reduce radiation dose — to all patients, but especially to pediatric patients— has become a focus in many radiology practices.The purpose of this presentation will be to first describe several of the components of CT image quality — noise, slice thickness (Z‐axis resolution), low contrast resolution and high contrast resolution— as well as radiation dose and to describe how each of these may be affected by technical parameter selection. This presentation will pay particular attention to the tradeoffs that exist between different aspects of image quality, especially when the reduction of radiation dose is one of the objectives.The presentation will then explore several mechanisms that can be used to reduce radiation dose in CT exams and the implications for the diagnostic image quality of the exam. Specifically, the implications of varying the tube current*time product (mAs), pitch or tablespeed (or for axial imaging, the table increment), slice thickness, beam energy (kVp), patient (or phantom) size and dose reduction options (such as tube current modulation) will be described for both radiation dose and diagnostic image quality. Finally, this presentation will emphasize that the tradeoffs between radiation dose and image quality are clinical‐task dependent; that is, the goals of the clinically indicated exam dictate what aspect of image quality may be emphasized for that exam (low contrast resolution or high contrast spatial resolution, etc.) and this will have implications for the amount of radiation dose reduction that is acceptable. This will be illustrated with examples from selected diagnostic imaging exams.Educational Objectives:1. Understand key components of image quality in CT scanning as well as reinforce CT radiation dose concepts.2. Understand the impact that technical parameter selection has on the various aspects of image quality and radiation dose.3. Examine the tradeoffs between various aspects of image quality and radiation dose.4. Examine the impact of these tradeoffs on a few clinical imaging protocols and illustrate the task‐dependence of image quality requirements.

Digitizing high-quality microscopic images and developing input/output technology for displaying those results is critical to tele-pathology in which pathological microscopic images are transferred to remote locations where they are diagnosed by specialists. This paper will discuss the results achieved by directly digitizing pathological microscopic images at a 2k by 2k resolution, and then using a super high definition imaging system to analyze their signals and evaluate compression performance. We will start off by digitizing samples that a pathologist will actually use in making a diagnosis, and then analyze their color distribution and spatial frequencies characteristics by comparing them to general images. This will make it apparent that such pathological images characteristically contain high spatial frequency in their chrominance components. We will also discuss the evaluation results of color differences for L.a.b space and compression ratios achieved when using JPEG to encode pathological images. We will also present a subjective evaluation of the influence sub- sampling of chrominance components has on image quality.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

BackgroundIncreased availability of HIV care over the past decade has dramatically reduced morbidity and mortality among people living with HIV (PLWH) in sub-Saharan Africa. However, perceived and experienced barriers to care, including dissatisfaction with services, may impact adherence and viral suppression. We examined the associations between satisfaction with HIV care and antiretroviral therapy (ART) adherence and viral load suppression.MethodsThe African Cohort Study (AFRICOS) is a prospective observational study conducted at PEPFAR-supported clinics in four African countries. At enrollment and twice-yearly study visits, participants received a clinical assessment and a socio-behavioral questionnaire was administered. Participants were classified as dissatisfied with care if they reported dissatisfaction with any of the following: waiting time, health care worker skills, health care worker attitudes, quality of clinic building, or overall quality of care received. Robust Poisson regression was used to estimate prevalence ratios and 95% confidence intervals (CIs) for associations between satisfaction with care and ART adherence and between satisfaction with care and viral suppression (viral load < 1000 copies/mL).ResultsAs of 1 March 2020, 2928 PLWH were enrolled and 2311 had a year of follow-up visits. At the first annual follow-up visit, 2309 participants responded to questions regarding satisfaction with quality of care, and 2069 (89.6%) reported satisfaction with care. Dissatisfaction with waiting time was reported by 177 (7.6%), building quality by 59 (2.6%), overall quality of care by 18 (0.8%), health care worker attitudes by 16 (0.7%), and health care worker skills by 15 (0.7%). After adjusting for age and site, there was no significant difference in viral suppression between those who were satisfied with care and those who were dissatisfied (aPR: 1.03, 95% CI 0.97–1.09). Satisfaction with HIV care was moderately associated with ART adherence among AFRICOS participants (aPR: 1.09; 95% CI 1.00–1.16).ConclusionsWhile patient satisfaction in AFRICOS was high and the association between perceived quality of care and adherence to ART was marginal, we did identify potential target areas for HIV care improvement, including reducing clinic waiting times.

BackgroundInterruptions are endemic in healthcare work environments. Yet, they can have positive effects in some instances and negative in others, with their net effect on quality of care still poorly...

Objectives: To report the capabilities of a patient satisfaction questionnaire in capturing factors which are important to patients in their evaluations of the quality of care provided to them. Design: An experienced research officer introduced the study to all patients with defined tracer conditions in the Saskatoon Health Region from Jan to April of 2009. Patients who agreed to participate returned their completed questionnaire directly to the research officer or placed them in a special box held by the nursing unit clerk on their unit. Measures: The instrument contained: 18 items of the General Practice Assessment Questionnaire for physicians and nurses; as well as single items capturing patient observations regarding: attentiveness of nurses; tidiness of facilities; efficiency of tests and treatments; patient comments; and a grading scale assessing overall quality of care. Contextual items covered health status, expenses, insurance and demographics. A provider care model and a client satisfaction model were constructed and tested. Results: Almost 96 percent of eligible patients (n=378) completed the questionnaire. The provider care model explained 84.2 percent of the variation in patients’ assessments of overall quality; and the client satisfaction model explained 67.6 percent of the variation. The quality of nursing and medical care were, the most important factors; however, attentiveness, tidiness, efficiency, and quantified comments each explained small but significant percentages of variance in overall quality. Conclusions: Patients consider separate dimensions in their assessments of overall quality of care. While quality of care by professionals trumps other considerations, the passive role for patients is fading.

Deep learning reconstruction (DLR) algorithms have begun replacing iterative reconstruction (IR) in CT. Besides the potential to reduce noise, the application of artificial intelligence can also allow for "super resolution," allowing traditional CT systems to produce images with improved spatial resolution by training against higher-resolution images. This study aims to characterize the image quality produced by a DLR "super resolution" algorithm. This study compares Canon's Precise IQ Engine (PIQE) Cardiac, a DLR algorithm, with the AIDR Enhanced 3D iterative reconstruction (IR) algorithm using quantitative phantom-based image quality measurements. Scans of the American College of Radiology (ACR) Gammex 464 image quality phantom with and without a torso-sized elliptical ring were acquired using CTDIvol of 2.6, 15.7, and 32.9 mGy. Each experimental condition was scanned 20 times. Reconstructions used AIDR with a cardiac kernel and PIQE Cardiac with both 512×512 and 1024×1024 matrices. The task-based modulation transfer function (MTFtask) was calculated for Teflon, acrylic, polyethylene, and air inserts. Contrast-to-noise ratio (CNR) and low-contrast object specific CNR (CNRLO) were calculated for the 25-mm and 6-mm low-contrast disks in module 2 of the phantom. NPS and noise magnitude were calculated from the module's background. Both versions of PIQE showed improvement in MTFtask over AIDR for most frequencies, with PIQE 1024 outperforming PIQE 512. Larger differences were noted at higher contrast levels and with the smaller phantom. NPS curves for PIQE 512 and PIQE 1024 were nearly identical at all doses. AIDR showed a noise magnitude at least 44% higher than PIQE for all scenarios. The NPS shapes differed between AIDR and PIQE, producing noticeably different noise textures that were dose- and phantom size-dependent. CNRLO values were similar between PIQE 512 and PIQE 1024 and were higher than those of AIDR for most scenarios; however, AIDR outperformed PIQE for the 6-mm objects at the medium and high doses. Use of PIQE on the 25-mm disk permits dose reductions in the small phantom without loss of CNRLO. PIQE provides substantial image quality improvements over AIDR in phantom-based quantitative measurements. The potential for dose reduction is also noted. PIQE 1024 can be used to improve the spatial resolution over PIQE 512, with no apparent trade-offs in image quality.

Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study

Quality of care by nurses is a key factor in determining the success of healthcare delivery around the globe, which is impacted by a shortage of nurses, excessive workloads, and unfavorable working conditions, including in the Republic of Fiji Islands. Using the Quality Health Outcome Model, this descriptive-predictive, cross-sectional study examined the quality of care and its predictors among 744 Fijian registered nurses from three tertiary hospitals. Instruments for data collection were the Demographic Data Sheet, the Quality of Care Scale, the Participation in Decision Making Scale, the Relational Coordination Survey, the Perception of Organizational Change Scale, the Job Satisfaction Scale, and the Organizational Commitment Questionnaire. Descriptive statistics and logistic regression analysis were applied to analyze the data. This study’s findings are informative and offer a glimmer of hope since 72.58% of participants perceived the overall quality of care as good/excellent, indicating a positive baseline. Two factors, relational coordination and job satisfaction, significantly affected the perception of the quality of care. The study model explained 8.90% of the variance in quality of care, with relational coordination being the strongest predictor. These findings provide a clear path to improvement. A comprehensive model should be developed and tested to better understand the factors predicting Fiji’s quality of care before it can be used to design an effective intervention. Developing nursing skills, improving good communication and work environments, and providing high-quality education and training among nurses can significantly improve the quality of care. In addition, support from the government for appropriate medical equipment, recruitment and retention strategies for nurses, and promotion of standard of care from the Ministry of Health and Medical Services are recommended to enhance the quality of care, further bolstering this hopeful outlook. Further Fijian nursing research is clearly needed on this topic in the future.

BackgroundPatients’ reported opinions of the health system need to be understood in order to provide patient-centered care. We investigated determinants of women’s ratings of the quality of care during their most recent facility delivery.MethodsWe conducted a census of all deliveries in the 6 weeks to 12 months preceding the survey, in villages served by 24 primary care clinics in rural Pwani Region, Tanzania. Women who had delivered children in a study facility were included in this analysis (n = 855). We interviewed women about demographic and obstetric factors and the quality of their obstetric care using a structured questionnaire. We created a composite index of perceived quality from six quality questions. We also assessed the functioning of the local health clinic using structured surveys. We used a multi-level model to analyze factors associated with women’s rating of the quality of care during delivery.Results14% of respondents rated the overall quality of care received during delivery as excellent. Women who listened to the radio daily reported lower quality composite scores (β: -0.99, p < 0.001). Women who reported receiving more services in ANC had higher quality scores (β: 0.46, p = 0.001), as did women receiving more delivery services (β: 0.55, p < 0.001). Women who reported disrespect and abuse during delivery had significantly lower quality scores (β: -4.13, p < 0.001).ConclusionsA woman’s expectations and prior and current experiences influence her perception of the quality of care she received. Health facility characteristics did not influence ratings of overall quality. Focusing on improving the process rather than inputs of service delivery during ANC visits and delivery may increase perceived quality of delivery care in low-resource settings.Trial registrationISRCTN17107760