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Global Health Collaboration: Unlocking a Healthier World, One Saturday at a Time 全球卫生合作:一个星期六,一次开启一个更健康的世界。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-01 DOI: 10.1016/j.jacr.2024.09.001
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引用次数: 0
Socio-Economic Factors and Clinical Context Can Predict Adherence to Incidental Pulmonary Nodule Follow-up via Machine Learning Models 社会经济因素和临床环境可通过机器学习模型预测偶然肺结节随访的依从性。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-01 DOI: 10.1016/j.jacr.2024.02.031

Objective

To quantify the relative importance of demographic, contextual, socio-economic, and nodule-related factors that influence patient adherence to incidental pulmonary nodule (IPN) follow-up visits and evaluate the predictive performance of machine learning models utilizing these features.

Methods

We curated a 1,610-subject patient data set from electronic medical records consisting of 13 clinical and socio-economic predictors and IPN follow-up adherence status (timely, delayed, or never) as the outcome. Univariate analysis and multivariate logistic regression were performed to quantify the predictors’ contributions to follow-up adherence. Three additional machine learning models (random forests, neural network, and support vector machine) were fitted and cross-validated to examine prediction performance across different model architectures and evaluate intermodel concordance.

Results

On univariate basis, all 13 predictors except comorbidity were found to have a significant association with follow-up. In multiple logistic regression, inpatient or emergency clinical context (odds ratio favoring never following up: 7.28 and 8.56 versus outpatient, respectively) and high nodule risk (odds ratio: 0.25 versus low risk) are the most significant predictors of follow-up, and sex, race, and marital status become additionally significant if clinical context is removed from the model. Clinical context itself is associated with sex, race, insurance, employment, marriage, income, nodule risk, and smoking status, suggesting its role in mediating socio-economic inequities. On cross-validation, all four machine learning models demonstrated comparable and good predictive performances, with mean area under the curve ranging from 0.759 to 0.802, with sensitivity 0.641 to 0.660 and specificity 0.768 to 0.840.

Conclusion

Socio-economic factors and clinical context are predictive of IPN follow-up adherence, with clinical context being the most significant contributor and likely representing uncaptured socio-economic determinants.
目的量化影响患者坚持偶发肺结节(IPNs)随访的人口、环境、社会经济和结节相关因素的相对重要性,并评估利用这些特征的机器学习模型的预测性能:我们从电子病历(EHR)中收集了 1610 个受试者的患者数据集,其中包括 13 个临床和社会经济预测因素,并将 IPN 随访依从性状态(及时/延迟/从不)作为结果。通过单变量分析和多变量逻辑回归来量化预测因素对随访依从性的影响。另外还拟合了三个机器学习模型(随机森林、神经网络和支持向量机)并进行了交叉验证,以检验不同模型架构的预测性能,并评估模型间的一致性:在单变量基础上,除合并症外,其他 13 个预测因素均与随访有显著关联。在多元逻辑回归中,住院病人或急诊病人的临床背景(与门诊病人相比,从不随访的OR值分别为7.28和8.56)和高结节风险(与低风险相比,OR值为0.25)是随访的最重要预测因素,而如果将临床背景从模型中剔除,性别、种族、婚姻状况则变得更加重要。临床背景本身与性别、种族、保险、就业、婚姻、收入、结节风险和吸烟状况相关,这表明临床背景在调解社会经济不平等方面发挥了作用。在交叉验证中,所有四个机器学习模型都表现出了相当好的预测性能,平均AUC为0.759-0.802,灵敏度为0.641-0.660,特异性为0.768-0.840:社会经济因素和临床环境可预测 IPN 随访的依从性,其中临床环境的作用最大,可能代表了未捕捉到的社会经济决定因素。
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引用次数: 0
Understanding Provider Cost of MRI for Appendicitis in Children: A Time-Driven Activity-Based Costing Analysis 了解儿童阑尾炎核磁共振成像的供应商成本:基于时间驱动活动的成本核算分析。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-01 DOI: 10.1016/j.jacr.2024.05.008

Objective

To use time driven activity-based costing to characterize the provider cost of rapid MRI for appendicitis compared to other MRI examinations billed with the same Current Procedural Terminology codes commonly used for MRI appendicitis examinations.

Methods

Rapid MRI appendicitis examination was compared with MRI pelvis without intravenous contrast, MRI abdomen/pelvis without intravenous contrast, and MRI abdomen/pelvis with intravenous contrast. Process maps for each examination were created through direct shadowing of patient procedures (n = 20) and feedback from relevant health care professionals. Additional data were collected from the electronic medical record for 327 MRI examinations. Practical capacity cost rates were calculated for personnel, equipment, and facilities. The cost of each step was calculated by multiplying the capacity cost rate with the mean duration of each step. Stepwise costs were summed to generate a total cost for each MRI examination.

Results

The mean duration and costs for MRI examination type were as follows: MRI appendicitis: 11 (range: 6-25) min, $20.03 (7.80-44.24); MRI pelvis without intravenous contrast: 55 (29-205) min, $105.99 (64.18-285.13); MRI abdomen/pelvis without intravenous contrast: 65 (26-173) min, $144.83 (61.16-196.50); MRI abdomen/pelvis with intravenous contrast: 128 (39-303) min, $236.99 (102.62-556.54).

Conclusion

The estimated cost of providing a rapid appendicitis MRI examination is significantly less than other MRI examinations billed using Current Procedural Terminology codes typically used for appendicitis MRI. Mechanisms to appropriately bill rapid MRI examinations with limited sequences are needed to improve cost efficiency for the patient and to enable wider use of limited MRI examinations in the pediatric population.
目的:采用基于时间驱动活动的成本计算(TDABC)方法,对快速磁共振成像阑尾炎检查与其他磁共振成像阑尾炎检查常用的当前程序技术(CPT)代码计费的提供商成本进行比较:将快速磁共振阑尾炎检查与不使用静脉注射造影剂的磁共振骨盆检查、不使用静脉注射造影剂的磁共振腹部/骨盆检查以及使用静脉注射造影剂的磁共振腹部/骨盆检查进行比较。通过直接观察患者的检查过程(20 人)和相关医护人员的反馈,绘制了每种检查的流程图。此外,还从 327 次核磁共振成像检查的电子病历中收集了其他数据。计算了人员、设备和设施的实际能力成本率。将能力成本率乘以每个步骤的平均持续时间,即可计算出每个步骤的成本。将每个步骤的成本相加,得出每次核磁共振成像检查的总成本:核磁共振成像检查类型的平均持续时间和费用如下:MRI 阑尾炎:11(范围:6-25)分钟,20.03 美元(7.80-44.24);MRI 骨盆,无静脉注射造影剂:55(29-205)分钟,105.99 美元(64.18-285.13);MRI 腹部/骨盆,无静脉注射造影剂:55(29-205)分钟,105.99 美元(64.18-285.13)。13);不使用静脉造影剂的 MRI 腹部/骨盆:65(26-173)分钟,144.83 美元(61.16-196.50);使用静脉造影剂的 MRI 腹部/骨盆:128(39-303)分钟,236.99 美元(102.62-556.54):结论:提供快速阑尾炎 MRI 检查的估计成本明显低于使用阑尾炎 MRI 常用 CPT 代码计费的其他 MRI 检查。为了提高患者的成本效益,并使有限磁共振成像检查在儿科人群中得到更广泛的应用,需要建立适当的机制对有限序列的快速磁共振成像检查进行收费。
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引用次数: 0
Patient-Friendly Summary of the ACR Appropriateness Criteria®: Pretreatment Evaluation and Follow-up of Invasive Cancer of the Cervix ACR 适宜性标准®患者友好型摘要:宫颈浸润癌的治疗前评估和随访。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.017
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引用次数: 0
Evaluating the Diversity and Representation of Artificial Intelligence–Generated Images of Radiologists: An Observational Study 评估人工智能生成的放射科医生图像的多样性和代表性:一项观察研究
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.05.004
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引用次数: 0
Finding Common Ground: The Intersection of Science, Creativity, and the Human Connection 寻找共同点:科学、创造力和人际关系的交汇点。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2023.08.033
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引用次数: 0
Patient-Friendly Summary of the ACR Appropriateness Criteria®: Acute Pelvic Pain in the Reproductive Age Group ACR 适宜性标准®患者友好型摘要:生殖年龄组急性盆腔疼痛。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.019
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引用次数: 0
The Role of Allies in Successful Change Management 盟友在成功变革管理中的作用。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.03.008
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引用次数: 0
Practical Insights From Integrating Financial Hardship Screening at a Comprehensive Cancer Center 综合癌症中心整合经济困难筛查的实用见解。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.08.001
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引用次数: 0
Patient-Friendly Summary of the ACR Appropriateness Criteria®: Acute Respiratory Illness in Immunocompromised Patients ACR 适宜性标准®患者友好摘要:免疫力低下患者的急性呼吸道疾病。
IF 4 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-09-01 DOI: 10.1016/j.jacr.2024.04.014
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引用次数: 0
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Journal of the American College of Radiology
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