Atlantic Health System

About: Atlantic Health System is a healthcare organization based out in Morristown, New Jersey, United States. It is known for research contribution in the topics: Catheter ablation & Antiarrhythmic agent. The organization has 277 authors who have published 299 publications receiving 6594 citations.

Reducing errors made by emergency physicians in interpreting radiographs: longitudinal study

Abstract: Objectives To reduce errors made in the interpretation of radiographs in an emergency department. Design Longitudinal study. Setting Hospital emergency department. Interventions All staff reviewed all clinically significant discrepancies at monthly meetings. A file of clinically significant errors was created; the file was used for teaching. Later a team redesigned the process. A system was developed for interpreting radiographs that would be followed regardless of the day of the week or time of day. All standard radiographs were brought directly to the emergency physician for immediate interpretation. Radiologists reviewed the films within 12 hours as a quality control measure, and if a significant misinterpretation was found patients were asked to return. Main outcome measures Reduction in number of clinically significant errors (such as missed fractures or foreign bodies) on radiographs read in the emergency department. Data on the error rate for radiologists and the effect of the recall procedure were not available so reliability modelling was used to assess the effect of these on overall safety. Results After the initial improvements the rate of false negative errors fell from 3% (95% confidence interval 2.8% to 3.2%) to 1.2% (1.03% to 1.37%). After the processes were redesigned it fell further to 0.3% (0.26% to 0.34%). Reliability modelling showed that the number of potential adverse effects per 1000 cases fell from 19 before the improvements to 3 afterwards and unmitigated adverse effects fell from 2.2/1000 before to 0.16/1000 afterwards, assuming 95% success in calling patients back. Conclusion Systems of radiograph interpretation that optimise the skills of all clinicians involved and contain reliable processes for mitigating errors can reduce error rates substantially.

Orexin System: The Key for a Healthy Life

Abstract: The orexin-A/hypocretin-1 and orexin-B/hypocretin-2 are neuropeptides synthesized by a cluster of neurons in the lateral hypothalamus and perifornical area Orexin neurons receive a variety of signals related to environmental, physiological and emotional stimuli, and project broadly to the entire CNS Orexin neurons are “multi-tasking” neurons regulating a set of vital body functions, including sleep/wake states, feeding behaviour, energy homeostasis, reward systems, cognition and mood Furthermore, a dysfunction of orexinergic system may underlie different pathological conditions The selective loss orexin neurons was found in narcolepsia, supporting the crucial role of orexins in maintaining wakefulness In animal models, orexin deficiency lead to obesity even if the consume of calories is lower than wildtype counterpart Reduced physical activity appears the main cause of weight gain in these models resulting in energy imbalance Interestingly, orexinergic neurons show connections to regions involved in cognition and mood regulation, including hippocampus Orexins enhance hippocampal neurogenesis and improve spatial learning and memory abilities, and mood Conversely, orexin deficiency results in learning and memory deficits, and depression

Image-guided radiotherapy for prostate cancer by CT-linear accelerator combination: prostate movements and dosimetric considerations.

Abstract: Purpose Multiple studies have indicated that the prostate is not stationary and can move as much as 2 cm. Such prostate movements are problematic for intensity-modulated radiotherapy, with its associated tight margins and dose escalation. Because of these intrinsic daily uncertainties, a relative generous “margin” is necessary to avoid marginal misses. Using the CT-linear accelerator combination in the treatment suite (Primatom, Siemens), we found that the daily intrinsic prostate movements can be easily corrected before each radiotherapy session. Dosimetric calculations were performed to evaluate the amount of discrepancy of dose to the target if no correction was done for prostate movement. Methods and materials The Primatom consists of a Siemens Somatom CT scanner and a Siemens Primus linear accelerator installed in the same treatment suite and sharing a common table/couch. The patient is scanned by the CT scanner, which is movable on a pair of horizontal rails. During scanning, the couch does not move. The exact location of the prostate, seminal vesicles, and rectum are identified and localized. These positions are then compared with the planned positions. The daily movement of the prostate and rectum were corrected for and a new isocenter derived. The patient was treated immediately using the new isocenter. Results Of the 108 patients with primary prostate cancer studied, 540 consecutive daily CT scans were performed during the last part of the cone down treatment. Of the 540 scans, 46% required no isocenter adjustments for the AP-PA direction, 54% required a shift of ≥3 mm, 44% required a shift of >5 mm, and 15% required a shift of >10 mm. In the superoinferior direction, 27% required a shift of >3 mm, 25% required a shift of >5 mm, and 4% required a shift of >10 mm. In the right–left direction, 34% required a shift of >3 mm, 24% required a shift of >5 mm, and 5% required a shift of >10 mm. Dosimetric calculations for a typical case of prostate cancer using intensity-modulated radiotherapy with 5-mm margin coverage from the clinical target volume (prostate gland) was performed. With a posterior shift of 10 mm for the prostate, the dose coverage dropped from 95–107% to 71–100% coverage. Conclusion We have described a technique that corrects for the daily prostate motion, allowing for extremely precise prostate cancer treatment. This technique has significant implications for dose escalation and for decreasing rectal complications in the treatment of prostate cancer.

Pulmonary Artery Acceleration Time Provides a Reliable Estimate of Invasive Pulmonary Hemodynamics in Children

Abstract: Background Pulmonary artery acceleration time (PAAT) is a noninvasive method to assess pulmonary hemodynamics, but it lacks validity in children. The aim of this study was to evaluate the accuracy of Doppler echocardiography–derived PAAT in predicting right heart catheterization (RHC)–derived pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), and compliance in children. Methods Prospectively acquired and retrospectively measured Doppler echocardiography–derived PAAT and RHC-derived systolic PAP, mean PAP (mPAP), indexed PVR (PVRi), and compliance were compared using regression analysis in a derivation cohort of 75 children (median age, 5.3 years; interquartile range, 1.3–12.6 years) with wide ranges of pulmonary hemodynamics. To account for heart rate variability, PAAT was adjusted for right ventricular ejection time and corrected by the RR interval. Regression equations incorporating PAAT and PAAT/right ventricular ejection time from the derivation cohort were then evaluated for the accuracy of their predictive values for invasive pulmonary hemodynamics in a validation cohort of 50 age- and weight-matched children with elevated PAP and PVR. Results There were significant inverse correlations between PAAT and RHC-derived mPAP ( r = −0.82) and PVRi ( r = −0.78) and a direct correlation ( r = 0.78) between PAAT and pulmonary compliance in the derivation cohort. For detection of pulmonary hypertension (PRVi > 3 Wood units · m 2 and mPAP > 25 mm Hg), PAAT r = 0.88 and r = 0.83, respectively), small biases ( Conclusions PAAT inversely correlates with RHC-measured pulmonary hemodynamics and directly correlates with pulmonary arterial compliance in children. The study established PAAT-based regression equations in children to accurately predict RHC-derived PAP and PVR.