Yield of chest computed tomography angiogram in cystic fibrosis patients with suspected pulmonary embolism.

INTRODUCTION: Individuals with cystic fibrosis (CF) may be at increased risk of pulmonary embolism (PE). Symptoms of PE overlap substantially with those of CF respiratory exacerbations. CF patients commonly undergo chest computed tomography (CT) angiograms (CTPA) to evaluate for PE, but little is known about the clinical presentation and diagnosis of PE in this population. OBJECTIVES: The objectives of this study are to determine the diagnostic yield of CTPA for PE in adult patients with CF and assess the utility of the Revised Geneva Score (RGS) in this population. METHODS: Retrospective review of all CTPA results was performed on CF patients with suspected PE at a large CF center from 1 January 2011 through 31 March 2017. Patient demographics, medical history, and presenting signs and symptoms were abstracted by chart review. RESULTS: A total of 103 unique CTPA studies were performed in 68 patients. Most were hospitalized at the time of CTPA, predominantly for respiratory manifestations of CF. CTPA identified four patients with PE. The small number of positive studies precluded analysis of predictors of PE. Fewer PE were diagnosed than predicted by the Revised Geneva Score, which was intermediate probability in 77/103 (75%) patients. CONCLUSION: The prevalence of PE in CF patients undergoing CTPA for suspected PE was 4%, which is lower than predicted by the Revised Geneva Score. This may be due to a large overlap in the signs and symptoms of PE and exacerbations of CF lung disease.

Intravenous blood pool activity masquerading as gastrointestinal hemorrhage.

Radiolabeled red blood cell (RBC) scintigraphy is a common study to detect and localize gastrointestinal hemorrhage. There are many potential entities that may result in false-positive RBC scintigraphy. Here, we present a case of enlarged feeding vessels of omental carcinomatosis which scintigraphically might be mistaken as intraluminal bowel activity and thus active hemorrhage. This case highlights the importance of reviewing correlative imaging in patients with a large neoplastic burden.

Technical Peer Review: Methods and Outcomes.

Peer review is routine among physicians, nurses, and pharmacy staff yet is uncommon in the field of nuclear medicine technology. Although not a requirement of regulatory agencies, nuclear medicine technical peer review can greatly enhance the quality of patient care in both hospital and outpatient settings. To date, detailed methods for accomplishing this task have not been published. Methods: 19,688 nuclear medicine studies performed at a single institution over a 5-y period were critically reviewed. Major findings (errors with potential to change physician interpretation of the study or resulting in prescription error) and minor findings (errors without an adverse effect on study outcome or interpretation) were identified and tabulated monthly according to finding type, study type, and individual staff member. Results: The technical peer review method used at our institution provided a comprehensive means to measure the rate and types of errors. Over time, this system tracked the performance of nuclear medicine staff and students, providing feedback that led to a measurable reduction in errors. Conclusion: We present a technical peer review system based on our own experience that can be adapted by other nuclear medicine facilities to fit their needs.

Implementing and sustaining a hand hygiene culture change programme at Auckland District Health Board.

AIM: In January 2009 Auckland District Health Board commenced implementation of the Hand Hygiene New Zealand (HHNZ) programme to bring about a culture change and to improve hand hygiene compliance by healthcare workers. We describe the implementation process and assess the effectiveness of this programme 36 months after implementation. METHOD: In keeping with the HHNZ guideline the implementation was divided into five steps: roll-out and facility preparation, baseline evaluation, implementation, follow-up evaluation and sustainability. The process measure was improvement in hand hygiene compliance and the outcome measure was Staphylococcus aureus clinical infection and bacteraemia rates. RESULTS: The mean (95% CI; range) baseline compliance rates for the national reporting wards was 35% (95% CI 24-46%, 25-61%). The overall compliance by the 7th audit period was 60% (95% CI 46-74; range 47-91). All healthcare worker groups had improvement in compliance. The reduction in healthcare-associated S. aureus bacteraemia rates following the implementation was statistically significant (p=0.027). CONCLUSION: Compliance with hand hygiene improved following implementation of a culture change programme. Sustaining this improvement requires commitment and strong leadership at a senior level both nationally and within each District Health Board.

The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal.

In Nepal, many infections remain poorly characterized, partly due to limited diagnostic facilities. We studied consecutive febrile adults presenting to a general hospital in Kathmandu, Nepal. Of the 876 patients enrolled, enteric fever and pneumonia were the most common clinical diagnoses. Putative pathogens were identified in 323 (37%) patients, the most common being Salmonella enterica serotype Typhi and S. enterica serotype Paratyphi A (117), Rickettsia typhi (97), Streptococcus pneumoniae (53), Leptospira spp. (36), and Orientia tsutsugamushi (28). Approximately half of the Salmonella isolates were resistant to nalidixic acid. No clinical predictors were identified to reliably distinguish between the different infections. These findings confirm the heavy burden of enteric fever and pneumonia in Kathmandu, and highlight the importance of murine typhus, scrub typhus, and leptospirosis. Given the lack of reliable clinical predictors, the development of cheap and accurate diagnostic tests are likely to be of great clinical utility in this setting.