Evaluation of clinical and imaging biomarkers for the prediction of new onset diabetes following pancreatic resection.

PURPOSE: To identify clinical and imaging biomarkers that can predict the new onset of diabetes mellitus (NODM) within 1 year of pancreatic resection. METHODS: A retrospective chart review was conducted of 426 non-diabetic patients who underwent a pancreaticoduodenectomy or distal pancreatectomy at the University of Pittsburgh Medical Center between 2006 and 2016. Clinical characteristics and the patient's diabetic status at 1-year post resection were collected from the EMR. Imaging biomarkers included hepatic and pancreatic fat replacement, pancreatic calcifications, pancreatic duct diameter, pancreatic volume and body composition. Univariate and multivariable analyses were performed to demonstrate any predictive biomarkers of diabetes occurrence within 1 year of pancreatic resection. RESULTS: 135/426 (31.7%) patients developed NODM. The only significant clinical predictor was older age (OR 1.02, 95% CI 1.002-1.039, p = 0.032). Imaging characteristics found to be significant included hepatic steatosis (OR 1.777, 95% CI 1.094-2.886, p = 0.02), larger reduction in pancreas volume (OR 0.989, 95% CI 0.979-0.999, p = 0.027), and greater preoperative visceral fat (OR 1.004, 95% CI 1.001-1.006, p = 0.001). CONCLUSION: Age, presence of hepatic steatosis, change in pancreatic volume, and preoperative visceral fat are independent predictive biomarkers for NODM following pancreatic resection.

Radiology Online Patient Education Materials Provided by Major University Hospitals: Do They Conform to NIH and AMA Guidelines?

AIMS: The internet creates opportunities for Americans to access medical information about imaging tests and modalities to guide them in their medical decision-making. Owing to health literacy variations in the general population, the American Medical Association and National Institutes of Health recommend patient education resources to be written between the third and seventh grade levels. Our purpose is to quantitatively assess the readability levels of online radiology educational materials, written for the public, in 20 major university hospitals. MATERIALS AND METHODS: In September and October 2016, we identified 20 major university hospitals with radiology residency-affiliated hospital systems. On each hospital׳s website, we downloaded all radiology-related articles written for patient use. A total of 375 articles were analyzed for readability level using 9 quantitative readability scales that are well validated in the medical literature. RESULTS: The 375 articles from 20 hospital systems were collectively written at an 11.4 ± 3.0 grade level (range: 8.4-17.1). Only 11 (2.9%) articles were written at the recommended third to seventh grade levels. Overall, 126 (33.6%) were written above a full high-school reading level. University of Washington Medical Center׳s articles were the most readable with a reading level corresponding to 7.9 ± 0.9. CONCLUSIONS: The vast majority of websites at major academic hospitals with radiology residencies designed to provide patients with information about imaging were written above the nationally recommended health literacy guidelines to meet the needs of the average American. This may limit the benefit that patients can derive from these educational materials.

Evidence-Based Reporting: A Method to Optimize Prostate MRI Communications With Referring Physicians.

OBJECTIVE: The purpose of this study was to develop an evidence-based method to optimize prostate MRI reports that would improve communication between urologists and radiologists. MATERIALS AND METHODS: This quality improvement initiative was approved by the institutional Quality Improvement Review Committee. A structured report was developed containing essential components defined by local practice norms and Prostate Imaging Reporting and Data System (PI-RADS) lexicon version 2. Two hundred preintervention and 100 postintervention reports were retrospectively reviewed for essential components. Additionally, a sample of 40 reports generated before the intervention and 40 reports generated after the intervention that made use of the structured report were evaluated by a urologist and were scored on a 5-point scale for consistency, completeness, conciseness, clarity, likelihood to contact radiologist, and clinical impact. Variables were compared with ANOVA, chi-square, or Fisher exact test. RESULTS: Essential components of the report were utilization of the PI-RADSv2 lexicon, findings listed by lesion, reporting of pertinent positive and negative findings (extraprostatic extension, seminal vesicle, and neurovascular bundle invasion), and low word count. In postintervention reports, all essential measures were statistically improved except for mean report word count. The urologist indicated statistically improved consistency (before intervention, 2.7; after intervention, 3.5; χ2 < 0.001), completeness (before intervention, 2.8; after intervention, 3.3; χ2 < 0.001), clarity (before intervention, 2.9; after intervention, 3.3; χ2 < 0.05), and clinical impact (before intervention, 2.8; after intervention, 3.8; χ2 < 0.001) of the report with reduced perceived need to contact (before intervention, 3.2; after intervention, 2.1; χ2 < 0.001) the interpreting radiologist for explanation. CONCLUSION: The structured prostate MRI report resulted in improved communication with referring urologists as indicated by the increased perceived clinical impact of the report.