bluuebunny/crossref_metadata_2025_split huggingface dataset:
BT35 Quality improvement project: modernizing the inpatient dermatology handover
Authors: Shah Rishi , Whitehead Jenny , Ramoutar Amrika 
Published: June 2024

Abstract
Dermatology is unique in our region because it provides on-call services to multiple sites and different National Health Service (NHS) trusts locally. This presents a number of challenges as different NHS trusts utilize different information technology and procedural systems. This quality improvement project (QIP) aimed to find a solution to the problem of having an effective and efficient handover system for inpatients across different trusts. Prior to this QIP, the handover consisted of an email that was sent at the end of each day summarizing the inpatient cohort. This had several issues including missing details, delayed updates and not updating all of the relevant staff. The initial Plan Do Study Act (PDSA) cycle surveyed the clinical staff to assess whether there was a problem with the current handover and potential solutions that could be considered. The results showed that the team were dissatisfied with the current handover and the majority utilized the on-call service to find out about the inpatients. Of the available solutions, the majority of staff wanted to explore an online solution via Microsoft Teams. The main challenge with the proposed handover on Teams was maintaining patient confidentiality given the sensitivity of the data being held. This was reviewed with the clinical governance team and a data protection impact assessment was carried out and approved. A Teams group and handover file were then created. The feedback highlighted that the handover template needed optimization, resulting in a second PDSA cycle. Senior colleagues approved a suitable template that was then trialled on the Teams group for handover. The survey results showed a significant improvement in the content, accessibility, usability and means of handover. The main issue identified was that some staff did not know how to access the Teams group to view the handover. This was remedied with the creation of a standard operating procedure, which provided instructions on how to access and use the new handover. This QIP with two PDSA cycles provided a number of advantages such as the ability of the handover to be accessible to a predefined group of people from any site or trust, and that it can be updated in real time. It can also be utilized and updated during virtual board rounds. Most importantly, this change has created an effective and efficient means of handover, as is reflected in the results of the postintervention survey.
BT39 Teledermatology assessment of community skin lesion referrals: insights, challenges and recommendations
Authors: Nguyen Vivienne , Jones Ruth , Gupta Girish 
Published: June 2024

Abstract
Consultations for skin lesions rank are a very common reason for general practitioner (GP) visits, with the urgent suspicion of cancer (USOC) referral pathway directing potentially cancerous lesions to dermatologists in our region. Despite the valuable role of clinical photographs alongside referrals, the variable quality poses a significant challenge. From March to April 2023, 100 GP referrals containing photos in our USOC pathway underwent analysis by two independent consultant dermatologists. They provided their top three diagnoses with free-text comments on image quality. Notably, prevalent image comments included ‘out of focus (60%)’ and ‘poor illumination’ (55%). Dermoscopy images were included in 15 community photos. Consultant 1 (G.G.) identified seborrhoeic keratosis as the primary diagnosis in 32%, while consultant 2 (R.J.) noted it as the top diagnosis in 34%. Consultant 1 included the GP’s diagnosis in their top three differentials 40% of the time, while consultant 2 did so 30% of the time. Existing guidance on teledermatology image quality is limited but emphasizes clear, well-lit photos with proper focus, taken from various angles and distances. Despite this, our data reveal a noticeable deviation from these practices. We propose that possible contributory factors leading to poor-quality images include time constraints during GP consultations, lack of awareness regarding guidance, and the use of devices with suboptimal image resolution. Notably, there are no local specific guidelines for community photos in our area. Based on our findings, we have created a local guideline, emphasizing the need for clear, focused images where the lesion is centrally framed, utilizing natural sunlight ideally at an angle to highlight skin texture. Additionally, an enlarged photo is recommended, balancing size with the maintenance of focus on the area of interest. Teledermatology provides broader access to expert advice, facilitates timely consultations, improves efficiency, and encourages global collaboration. However, the heterogeneity in photos can lead to misdiagnosis, inappropriate triage, and inefficient resource allocation. The implementation of guidance for referral photos can optimize resource use, enhance patient satisfaction, and streamline workflow.
Duty of candour and clinically significant accidental or unintended exposures: revisiting the definition of moderate harm for patient safety incidents involving ionizing radiation
Authors: Kotre C John 
Published: June 2024

Abstract

Objective
To explore a quantitative interpretation of the term ‘moderate harm’ as applied to the triggering of the duty of candour associated with clinically significant accidental and unintended exposures to ionizing radiation.

Methods
Current definitions of ‘moderate harm’ were matched to the lay descriptions of disease and injury states used in the calculation of detriment as disability-adjusted life years (DALY) by the World Health Organization, to obtain a value of detriment associated with ‘moderate harm’. Published conversion factors between effective dose and DALY were used to calculate the effective dose associated with the same detriment.

Results
The DALY loss associated with a moderate harm incident is estimated as 0.0216 years. This corresponds to the detriment resulting from exposure to ionizing radiation of 21 mSv. An effective dose of 21 mSv relates to a probability of induced cancer of 0.0012.

Conclusion
The results obtained closely match existing guidance although the method used is completely different. It is concluded that there is no evidence to change the existing guidance on the triggering of DoC in radiation incidents.

Advances in knowledge
An alternative approach to linking ‘moderate harm’ and radiation detriment has reinforced existing guidance.
Techno–economic analysis of green hydrogen production by a floating solar photovoltaic system for industrial decarbonization
Authors: Muthia Rahma , Pramudya Anastasia Segari Putri , Maulana Mochamad Rafly , Purwanto Widodo Wahyu 
Published: June 2024

Abstract
This study proposes a conceptual design of green hydrogen production via proton exchange membrane electrolysis powered by a floating solar photovoltaic system. The system contributes to industrial decarbonization in which hydrogen blending with natural gas is proposed as an approach to smooth the energy transition. The proposed design addresses the challenge of supplying a continuous flow-rate of green hydrogen, which is typically demanded by industrial end users. This study particularly considers a realistic area required for the installation of a floating solar photovoltaic system. To enable the green hydrogen production of 7.5 million standard cubic feet per day, the required structure includes the floating solar photovoltaic system and Li-ion batteries with the nominal capacities of 518.4 megawatts and 780.8 megawatt-hours. This is equivalent to the requirement for 1 524 765 photovoltaic modules and 3718 Li-ion batteries. The assessment confirms the technical viability of the proposed concept of green hydrogen production, transportation and blending. While the present commercialization is hindered by economics due to a high green hydrogen production cost of USD 26.95 per kg, this green hydrogen pathway is expected to be competitive with grey hydrogen produced via coal gasification and via natural gas steam reforming by 2043 and 2047, respectively.
Quantification of myocardial blood flow using dynamic myocardial perfusion computed tomography
Authors: Gutierrez Guadarrama D , Rangel Calzada A , Vallejo E 
Published: June 2024

Abstract

Background
Cardiac CT angiography (CCTA) remains a limited method for evaluating the physiologic significance of coronary stenosis. On the other hand, dynamic techniques for evaluating myocardial perfusion imaging (MPI) allow quantification of myocardial blood flow (MBF) which may improve identification of hemodynamically relevance of luminal stenosis.

Objective
the purpose of this study was to determine the feasibility of vasodilator-stress CT-based dynamic MPI (CT-dMPI) for regional and global quantitively measurements of MBF for the identification of hemodynamically significant coronary stenosis.

Materials and methods
CCTA and CT-dMPI of 43 patients with chest pain were evaluated for the presence of coronary stenosis associated with perfusion defects and abnormal values of MBF (34 men and nine women; mean age, 60.9±12.9 years). Global MBF was quantified according to CT-dMPI and MBF values of normal and abnormal per-vessel territory (LAD, LCx and RCA) were correlated to the presence or not of coronary artery stenosis at CCTA. The relative MBF (rMBF) was calculated per vessel territory as the maximum coronary MBF divided by the reference MBF.

Results
In subjects without coronary plaques (Group I) the mean value of global MBF was 117.7±19.4 mL/100 mL/ml; LAD maximum blood flow was 130.9±9.7 mL/100 mL/ml; LCx maximum blood flow was 123.1±10.7 mL/100 mL/ml; RCA maximum blood flow was 128.1±7.3 mL/100 mL/ml; In patients without anatomically significant coronary stenosis or perfusion defects (Group II, 1%-69%) the mean value of global MBF was 127.5±26.2 mL/100 mL/ml; LAD maximum blood flow was 145.7±8.27 mL/100 mL/ml; LCx maximum blood flow was 134.5±8.1 mL/100 mL/ml; RCA maximum blood flow was 144.8±78.9 mL/100 mL/ml; In patients with significant stenosis (&gt;70%) the mean value of global MBF was 104.2±25.2 mL/100 mL/ml; LAD maximum blood flow was 110.4±7 mL/100 mL/ml; LCx maximum blood flow was 80.1±6.8 mL/100 mL/ml; RCA maximum blood flow was 92.7±5.9 mL/100 mL/ml; The median relative MBF was 0.73 for Group III and 0.93 for Group I and II. CT-dMPI demonstrated a sensitivity, specificity, PPV, NPV, and accuracy for the detection of significant stenosis of &gt;70% (Group III) 82%, 100%, 100% and, 94%.

Conclusions
vasodilator-stress CT-based dynamic MPI (CT-dMPI) for regional and global quantitively measurements of MBF is feasible and the findings correlate with the visual assessment of the presence of coronary artery stenosis at CCTA. CT-dMPI might improve the diagnostic accuracy for identifying flow-obstructing stenosis compared with CCTA alone.
Calcium density of the aortic valve: a comparison of its measurement between echocardiography and computed tomography in a cohort of South American patients with severe aortic stenosis
Authors: Guaman-Valdivieso C G , Lluberas N , Aramburu J , Parma G , Lluberas S , Lluberas R 
Published: June 2024

Abstract

Background/Introduction
The baseline calcium load of the valve is indicative of aortic stenosis progression. While echocardiography remains the standard study for severity assessment, with acknowledged limitations, computed tomography excels in its remarkable reproducibility in measurements, particularly through the calculation of the valve calcium score. The indexing of valve calcium to the area of the aortic ring, termed the calcium density of the aortic valve, has been proposed as an additional diagnostic and prognostic variable. In Asian populations, the diagnostic precision of the calcium score threshold is lower, suggesting that valve area density might be a more suitable reference. Local-level research on this variable is warranted.

Purpose
Correlate the measurement of aortic valve area density performed by computed tomography with that calculated using echocardiographic variables. Analyse whether the density of the aortic valve area has prognostic value concerning the presence of paravalvular leak one month after transcatheter aortic valve implantation (TAVI).

Methods
Analytical retrospective cohort study with prospective follow-up aimed at correlating the measurement of aortic valve area density performed by computed tomography with that calculated using echocardiographic variables and assessing its prognostic value. The registry was conducted at two centres. All patients with symptomatic severe aortic stenosis who underwent TAVI from June 2021 to June 2023 were included. The ethical guidelines were followed, respecting the anonymity of the data and the Declaration of Helsinki. Statistical analyses were performed using SPSS V.25, with a P value less than 0.05 considered significant.

Results
Sixty-three patients were included, 47.61% of whom were female, with a mean age of 82 years (Q1-Q3: 79; 86 years). A statistically significant correlation was found when assessing the density of the aortic ring area estimated from echocardiography compared to that estimated from computed tomography (Figure 1). In the examination of the ROC curves for the calcium score and the aortic valve calcium density, they were identified as poor predictors for paravalvular leak outcomes (Figure 2).

Conclusions
A correlation is observed between the density of the aortic valve area measured by computed tomography and that calculated with echocardiographic variables. However, they do not appear to hold prognostic value regarding the presence of a paravalvular leak one month after the TAVI procedure.
Improvement of myocardial perfusion SPECT studies with a cardio-dedicated CZT gamma camera. Comparison with an analogical SPECT/CT gamma camera
Authors: Aguade-Bruix S , Cardozo-Saavedra A , Palomar Munoz A , Aguirre E , Romero-Farina G , Cuellar-Calabria H , Pizzi M N , Roque A 
Published: June 2024

Abstract

Aim
To show the improvement in myocardial perfusion SPECT studies achieved in the year 2023 using a cardio-dedicated CZT gamma camera, compared to year 2021 when using an analogical SPECT/CT gamma camera.

Methods
We have collected data on nuclear cardiology care activity for the years 2021, 2022 and 2023, including patients treated in our institution. In 2021 myocardial perfusion imaging (MPI) studies were performed primarily on an analogical SPECT/CT gamma camera, which was replaced by a cardio-dedicated CZT in 2022. In 2023 MPI was carried out mainly in the new CZT gamma camera. For comparison we have selected the SPECT MPI studies performed in 2021 (one day protocol mainly with 18 + 12 minutes acquisition plus 10 minutes for in-out patient), and 2023 MPI studies (one day protocol mainly with 6 + 4 minutes acquisition plus 10 minutes for in-out patient).

Results
(Results Table) With the new CZT cardio-dedicated gamma camera, the number of stress SPECT increased by 442 (31%) and rest SPECT by 341 (23%), with a total annual increase of 783 SPECT studies (27%) in 2023 compared to 2021. Furthermore, the complexity of SPECT studies has increased in 2023, since part of the studies carried out (68) correspond to SPECT studies of myocardial blood flow, which are obtained in the same gamma camera simultaneously. In addition, the gamma camera acquisition time has reduced by 66% (from 30 to 10 minutes), and the patient total time has reduced by half (from 40 to 20 minutes). Counts in the cardiac area have increased on average more than 1000 times (14 million counts for a low dose study and 32 million for a high dose study).

Conclusions
The improvement achieved in SPECT studies for myocardial perfusion after upgrading to a cardio-dedicated CZT gamma camera has been an annual increase of 27% in number of SPECT studies, and a decrease in patient total time by half, which has allowed implementing more complex studies, such as evaluation of myocardial blood flow.
Cut-off values of myocardial blood flow using cardiac-dedicated CZT SPECT
Authors: Aguade-Bruix S , Cardozo Saavedra A , Aguirre E , Palomar Munoz A , Gamez Cenzano C , Ferreira Gonzalez I , Escobar Amores M , Herance Camacho R , Cuellar-Calabria H , Pizzi M N , Roque A , Romero-Farina G 
Published: June 2024

Abstract

Background
While not the primary mechanism or hallmark for the pathogenesis of all myocardial disease, coronary microvascular disease is acknowledged to play a crucial role in the diagnostic and prognosis of different diseases. PET is considered the non-invasive gold standard for evaluating myocardial blood flow, but SPECT-CZT cameras have become a promising and comparable tool for this purpose, more widespread in some countries. However, each SPECT-CZT trademark possesses different characteristics and each service adopts different protocols. This requires establishing specific cut-off values for our recently installed CZT SPECT camera.

Purpose
The aim of this study is to determine cut-off values of myocardial blood flow (MBF) using a cardiac-dedicated CZT SPECT in our population.

Methods
We prospectively analyzed 109 patients who underwent gated-SPECT using a cardiac-dedicated CZT SPECT. Of these, 43 (39.4%) subjects correspond to a control group (with normal myocardial perfusion in rest and stress, normal gated, normal coronary CT, without myocardial hypertrophy, diabetes or valvular heart disease, all subjects asymptomatic and in sinus rhythm) and 66 (60.6%) patients correspond to a pathological group (angina:10, diabetes: 23, dyspnea: 7, heart failure: 3, non-fatal myocardial infarction: 14, left ventricular ejection fraction &lt;50%: 9, coronary artery disease: 14, coronary revascularization: 9, valvular heart disease: 8). The cut-off values for MBF at rest (MBF-rest), MBF during stress or hyperemic phase (MBF-stress), MBF reserve (MBF-reserve: defined as MBF-stress/MBF-rest), and MBF differences (MBF-differences: MBF-stress - MBF-rest) were investigated. Statistical analyses were performed with Receiver Operating Characteristics (ROC) curve analysis using STATA 18. StataCorp, College Station, TX, USA.

Results
In order to differentiate control group and pathological group, cut-off values were (Results Table):

Conclusions
Different cut-off values of MBF were observed between subjects and patients using a cardiac-dedicated CZT SPECT camera.Results Table
Comparison between myocardial perfusion SPECT and cardiac magnetic resonance findings in non-ischemic dilated cardiomyopathy
Authors: Nunes R , Martins E , Dias P 
Published: June 2024

Abstract

Background
Dilated cardiomyopathy (DCM) is defined as the presence of left ventricular or biventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions or significant coronary heart disease. The diagnostic work-up for patients with DCM includes cardiac imaging and cardiac magnetic resonance (CMR) is the gold-standard method for detailed morphological caracterization. Although there is a limited diagnostic role for radionuclide imaging in DCM, myocardial perfusion single-photon emission computed tomography (SPECT) is commonly performed to exclude ischemic etiology.

Purpose
The aim of this study was to compare the findings of myocardial perfusion SPECT (MPS) and CMR in non-ischemic DCM.

Methods
We included 35 patients that had been diagnosed with DCM and underwent MPS and CMR for etiological diagnosis in our institution between January 2020 and December 2023. We evaluated left ventricular motility, thickening and perfusion defects in MPS, the presence of late gadolinium enhancement (LGE) in CMR and the values of left ventricular ejection fraction (LVEF), end-systolic and end-diastolic volumes in both exams.

Results
24 patients were male (69%), with a median age of 65,9 ± 11,8 years. Ischemic etiology for DCM was excluded based on CMR in 25 patients, 6 patients were diagnosed with alcoholic DCM, 3 patients with familial DCM and 1 with chemotherapy-induced cardiotoxicity. In 23 patients (66%), MPS showed diffuse motility and thickening abnormalities. In MPS, 34 patients (97%) had perfusion defects and 17 (50%) had reversible defects. 14 patients (41%) had only one perfusion defect while 20 (59%) patients had 2 or more. The septal wall was the most affected (24 patients - 69%). In 24 patients (69%), CMR showed LGE suggestive of fibrosis and in 88% of these patients the fibrosis was seen in the septal wall. A moderate correlation (0,508) was found between LVEF in MPS and CMR. 8 patients (33%) presented LGE in CMR and had non-reversible perfusion defects in the same myocardial wall in MPS while 12 patients (50%) presented with reversible perfusion defects in the same LGE location. Of the 12 patients that presented with LGE in CMR and reversible defects in MPS, 7 (58%) had total or parcial but significant reversibility and 5 (42%) had partial but non-significant reversibility.

Conclusions
The presence of perfusion defects is common in non-ischemic DCM. In most patients the perfusion defects (MPS) and fibrosis (CMR) were seen in the septal wall. Reversible defects may be explained by microvascular dysfunction known to play a role in DCM pathogenesis. These findings should be taken into account in the interpretation of MPS results in the etiological diagnosis of DCM.