The Automation of Software Development Metrics

With the push to streamline medical records and the use of electronic medical records system technology on the rise, successful implementation is important. The push is due in part for the need to reduce unnecessary paperwork, increase reimbursement, increase quality of medical records and increase overall quality of care. Factors to consider are the effects of implementation on quality of care, quality of medical records, physician and staff perceptions, working conditions, patient satisfaction, cost and barriers. Implementation may have a positive, negative or neutral effect on these factors making the need to review literature and report outcomes significant

Association of health anxiety and health care management skills to health-related quality of life in college students with a chronic medical condition

Adolescents and young adults (AYAs) with a chronic medical condition (CMC) are often tasked with increasing independent management of their health care as they transition from pediatric to adult medical care (i.e., transition readiness). The Health Care Transition Model highlights the need to understand individual predictors for greater transition readiness and subsequent health-related quality of life (HRQoL). Based on the Yerkes-Dodson theory, it is known that optimal levels of anxiety are motivating for behavior performance. However, the role of health anxiety in the development of transition readiness among AYAs with a CMC is unclear. I hypothesized that moderate/optimal levels of health anxiety would be quadratically associated with greater transition readiness and HRQoL outcomes. Ninety-eight AYA college students (87.6% female, 79.1% white, 76.5% underclassmen, 19.54 +/- 1.26 years old) completed online surveys of demographic information, health anxiety, transition readiness, and mental and physical HRQoL. Multiple linear regression results demonstrated linear, not quadratic, relationships between health anxiety and mental, b = -.435, t(92) = -4.82, p < .001, and physical HRQoL, b = -.504, t(93) = -6.10, p < .001. Multiple linear regression results indicated no associations between transition readiness and mental and physical HRQoL, and health anxiety and transition readiness. Two exploratory moderation analyses examining interactions between health anxiety and transition readiness on mental and physical HRQoL demonstrated a significant interaction effect for physical HRQoL. Across three quartiles of health anxiety, those in the lowest quartile demonstrated that greater transition readiness was associated with greater physical HRQoL, b = 3.49, 95% CI [.721, 6.260]. These findings are partially consistent with previous research indicating that greater health anxiety is associated with worse HRQoL outcomes; however, result do not support existing findings for associations between transition readiness and HRQoL. Results from the present study extend our understanding of the role of health anxiety in health care transition and associated HRQoL outcomes. In clinical settings, examining health anxiety in AYAs transitioning from pediatric to adult care and providing necessary support may bolster long-term HRQoL outcomes

Disparities in the completion of steps to kidney transplantation: protocol for a systematic review

Introduction Disparities in access to transplantation have been well documented. The extant literature, however, focuses largely on disparities and related barriers for African-American patients and none has used the steps to transplantation as a guiding framework. This review will catalogue disparities in the steps to transplantation as well as the barriers and facilitators to completion of each step identified in the extant literature. The results of the review will be used to generate recommendations for future research to improve equity in access to kidney transplantation. Methods and analysis Standard procedures will be used in the conduct of the review. Searches will be performed using the following electronic databases: PubMed/Medline, PsycINFO, CINHAL, EMBASE, Cochrane library and Web of Science. Reports of original research will be eligible for inclusion if they are published from 2005 to present, written or available in English language, performed in the USA, enrol adult participants (18 years of age or more), and employ descriptive or observational designs. Two authors will independently screen retrieved articles for inclusion. MaxQDA will be used for data analysis and management. All included reports will be coded for article characteristics; disparities identified; barriers and motivators of completion of steps to transplantation; and proposed solutions to disparities and barriers. Each report will be coded independently by two authors and discrepancies resolved by discussion among the full team. A qualitative approach to data analysis is planned. Risk of bias will be assessed using standard procedures. Ethics and dissemination The findings will provide crucial information on the current status of disparities in access to transplantation. PRISMA guidelines will be followed in reporting the results of the review. It is anticipated that these results will inform research which seeks to increase parity in access to transplantation. Systematic review registration PROSPERO CRD42014015027

Average absorbed breast dose (2ABD): an easy radiation dose index for digital breast tomosynthesis

Background: To propose a practical and simple method to individually evaluate the average absorbed dose for digital breast tomosynthesis. Methods: The method is based on the estimate of incident air kerma (ka,i) on the breast surface. An analytical model was developed to calculate the ka,i from the tube voltage, tube load, breast thickness, x-ray tube yield, and anode-filter combination. A homogeneous phantom was employed to simulate the breast in experimental measurements and to assess the dose-depth relationship. The ka,i values were employed to calculate the “average absorbed breast dose” (2ABD) index. Four mammographic units were used to develop and test our method under many conditions close to clinical settings. The average glandular dose (AGD) calculated following the method described by Dance et al., and the 2ABD computed through our method (i.e., from the exposure parameters) were compared in a number of conditions. Results: A good agreement was obtained between the ka,i computed through our model and that measured under different clinical conditions: discrepancies &lt; 6% were found in all conditions. 2ABD matches with a good accuracy the AGD for a 100% glandular-breast: the minimum, maximum, and mean differences were &lt; 0.1%, 7%, and 2.4%, respectively; the discrepancies increase with decreasing breast glandularity. Conclusions: The proposed model, based on only few exposure parameters, represents a simple way to individually calculate an index, 2ABD, which can be interpreted as the average absorbed dose in a homogeneous phantom, approximating a 100% glandular breast. The method could be easily implemented in any mammographic device performing DBT

Incorporating dose–volume histogram parameters of swallowing organs at risk in a videofluoroscopy-based predictive model of radiation-induced dysphagia after head and neck cancer intensity-modulated radiation therapy

Purpose: To develop a&nbsp;videofluoroscopy-based predictive model of radiation-induced dysphagia (RID) by incorporating DVH parameters of swallowing organs at risk (SWOARs) in a&nbsp;machine learning analysis. Methods: Videofluoroscopy (VF) was performed to assess the penetration-aspiration score&nbsp;(P/A) at baseline and at 6 and 12&nbsp;months after RT. An RID predictive model was developed using dose to nine SWOARs and P/A-VF data at 6&nbsp;and 12 months after treatment. A&nbsp;total of 72&nbsp;dosimetric features for each patient were extracted from DVH and analyzed with linear support vector machine classification (SVC), logistic regression classification (LRC), and random forest classification (RFC). Results: 38&nbsp;patients were evaluable. The relevance of SWOARs DVH features emerged both at 6 months (AUC 0.82 with SVC; 0.80 with LRC; and 0.83 with RFC) and at 12 months (AUC 0.85 with SVC; 0.82 with LRC; and 0.94 with RFC). The SWOARs and the corresponding features with the highest relevance at 6 months resulted as the base of tongue (V65 and Dmean), the superior (Dmean) and medium constrictor muscle (V45, V55; V65; Dmp; Dmean; Dmax and Dmin), and the parotid glands (Dmean and Dmp). On the contrary, the features with the highest relevance at 12 months were the medium (V55; Dmin and Dmean) and inferior constrictor muscles (V55, V65 Dmin and Dmax), the glottis (V55 and Dmax), the cricopharyngeal muscle (Dmax), and the cervical esophagus (Dmax). Conclusion: We trained and cross-validated an&nbsp;RID predictive model with high discriminative ability at both 6&nbsp;and 12 months after RT. We expect to improve the predictive power of this model by enlarging the number of training datasets

Average Absorbed Breast Dose (2ABD) to Mean Glandular Dose (MGD) Conversion Function for Digital Breast Tomosynthesis: A New Approach

Background: In this work a new method for the Mean Glandular Dose evaluation in digital breast tomosynthesis (DBT) is presented. Methods: Starting from the experimental-based dosimetric index, 2ABD, which represents the average absorbed breast dose, the mean glandular dose MGD2ABD was calculated using a conversion function of glandularity f(G), obtained through the use of Monte Carlo simulations.Results: f(G) was computed for a 4.5 cm thick breast: from its value MGD2ABD for different compressed breast thicknesses and glandularities was obtained. The comparison between MGD2ABD estimates and the dosimetric index provided in the current dosimetry protocols, following the Dance's approach, MGDDance, showed a good agreement (<10%) for all the analyzed breast thicknesses and glandularities. Conclusion: The strength of the proposed method can be considered an accurate mean glandular dose assessment starting from few and accessible parameters, reported in the header DICOM of each DBT exam

Image Quality Comparison between Digital and Synthetic 2D Mammograms: A Qualitative and Quantitative Phantom Study

The recent introduction of digital breast tomosynthesis (DBT) have lead to improvements in sensitivity and specificity of breast cancer detection, especially in cases of tumors developed in dense breasts. Since DBT provides tomographic slices of an entire tissue volume, it reduces the inherent tissue overlapping limitation of digital mammography (DM). In addition, DBT combined with DM has been proven to decrease recall and increase invasive cancer detection rates in breast cancer screening. However, the employment of DBT+DM implies a not negligible increment of patients absorbed dose. Therefore, Synthesized mammograms (SMs) generated from the DBT data have been recently introduced to eliminate the need of an additional DM. However, several studies showed differences between DM and SM images and some studies found contrasting results in terms of image quality when DM and SM images were compared. In our phantom study, we objectively compare image quality of SM and DM images in terms of noise, spatial resolution and contrast properties. Additionally, a qualitative analysis of the ACR mammographic phantom was performed in both modalities to assess the detectability of different features. SM images were characterized by different texture with respect to DM images, showing lower overall performances in terms of contrast-to-noise ratio and modulation transfer function. However, the goal of SM images is to provide a useful two-dimensional guide complementary to the DBT dataset and the performances in terms of high-contrast features detectability were satisfactory in comparison to those obtained in DM

Image resampling and discretization effect on the estimate of myocardial radiomic features from T1 and T2 mapping in hypertrophic cardiomyopathy

Radiomics is emerging as a promising and useful tool in cardiac magnetic resonance (CMR) imaging applications. Accordingly, the purpose of this study was to investigate, for the first time, the effect of image resampling/discretization and filtering on radiomic features estimation from quantitative CMR T1 and T2 mapping. Specifically, T1 and T2 maps of 26 patients with hypertrophic cardiomyopathy (HCM) were used to estimate 98 radiomic features for 7 different resampling voxel sizes (at fixed bin width), 9 different bin widths (at fixed resampling voxel size), and 7 different spatial filters (at fixed resampling voxel size/bin width). While we found a remarkable dependence of myocardial radiomic features from T1 and T2 mapping on image filters, many radiomic features showed a limited sensitivity to resampling voxel size/bin width, in terms of intraclass correlation coefficient (&gt; 0.75) and coefficient of variation (&lt; 30%). The estimate of most textural radiomic features showed a linear significant (p &lt; 0.05) correlation with resampling voxel size/bin width. Overall, radiomic features from T2 maps have proven to be less sensitive to image preprocessing than those from T1 maps, especially when varying bin width. Our results might corroborate the potential of radiomics from T1/T2 mapping in HCM and hopefully in other myocardial diseases

Evaluation of Dosimetric Properties in Full Field Digital Mammography (FFDM) - Development of a New Dose Index

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