Analytical fitting of γ-ray photopeaks in germanium cross strip detectors.

In an ideal germanium detector, fully-absorbed monoenergetic γ-rays will appear in the measured spectrum as a narrow peak, broadened into a Gaussian of width determined only by the statistical properties of charge cloud generation and the electronic noise of the readout electronics. Multielectrode detectors complicate this picture. Broadening of the charge clouds as they drift through the detector will lead to charge sharing between neighboring electrodes and, inevitably, low-energy tails on the photopeak spectra. We simulate charge sharing in our germanium cross strip detectors in order to reproduce the low-energy tails due to charge sharing. Our goal is to utilize these simulated spectra to develop an analytical fit (shape function) for the spectral lines that provides a robust and high-quality fit to the spectral profile, reliably reproduces the interaction energy, noise width, and the number of counts in both the true photopeak and the low-energy tail, and minimizes the number of additional parameters. Accurate modeling of the detailed line profiles is crucial for both calibration of the detectors as well as scientific interpretation of measured spectra.

What every dentist needs to know about the use of artificial intelligence in dentistry.

Artificial intelligence (AI) is a division of computer science that allows machines to emulate human cognitive processes. In dentistry, AI is applied in clinical decision-making and can aid in detecting disease and predicting patterns based on existing data sets. AI can assist clinicians by quickly analyzing massive amounts of data to improve workflow, identify patterns of disease, provide risk assessment, and create individualized patient-centered treatment plans. AI has been shown to increase efficiency in the office by aiding in scheduling, tracking, and updating patient records to better organize patient data. The objective of this article is to outline the various applications of AI in different dental specialties. Applications range from business functions such as marketing, cyber security, and report writing to clinical uses such as lesion detection and surgical guidance. This review will also discuss some of the ethical considerations and drawbacks associated with implementing AI in the dental practice.

Patient monitoring in the nonoperating room anesthesia (NORA) setting: current advances in technology.

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) procedures continue to increase in type and complexity as procedural medicine makes technical advances. Patients presenting for NORA procedures are also older and sicker than ever. Commensurate with the requirements of procedural medicine, anesthetic monitoring must meet the American Society of Anesthesiologists standards for basic monitoring. RECENT FINDINGS: There have been improvements in the required monitors that are used for intraoperative patient care. Some of these changes have been with new technologies and others have occurred with software refinements. In addition, specialized monitoring devises have also been introduced into NORA locations (depth of hypnosis, respiratory monitoring, point-of care ultrasound). These additions to the monitoring tools available to the anesthesiologist working in the NORA-environment push the boundaries of procedures which may be accomplished in this setting. SUMMARY: NORA procedures constitute a growing percentage of total administered anesthetics. There is no difference in the monitoring standard between that of an anesthetic administered in an operating room and a NORA location. Anesthesiologists in the NORA setting must have the same compendium of monitors available as do their colleagues working in the operating suite.

Nonoperating room anesthesia education: preparing our residents for the future.

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be introduced to residents as part of their education. RECENT FINDINGS: Topics for the future include, but are not limited to, new medications, artificial intelligence and big data, monitoring depth of hypnosis, translational innovation and collaboration, demographic changes, financial driving forces, destination hubs, medical tourism, and new approaches to education training and self-management. SUMMARY: Implementing new medical technologies for anesthesia outside the operating room will help to successfully master this ever evolving subspecialty. Anesthesiologists require specific preparation for the diverse settings that they will encounter during their training. In this rapidly changing field, cognitive fitness must be factored into teaching and evaluation of residents. We describe the most important topics to consider when educating anesthesiology residents, and highlight research that addresses upcoming challenges.

OR Management and Metrics: How It All Fits Together for the Healthcare System.

Increased healthcare costs and diminishing returns have prompted healthcare administrators to address budget allocations to alleviate institutional costs. Current economic constraints, such as limited Medicaid and Medicare insurance payments, limit our patients' ability to receive urgent surgical interventions as well as access preventative diagnostic tools. Rather than downsizing the workforce, future sustainability must be derived upon effective cost structures supported by improved quality control measures and increased patient accessibility. Surgeries were performed during 29% of hospitalizations and comprised 48% of the $387 billion in healthcare expenditures in 2011. Further, surgical procedures managed to account for 40-70% of hospital revenues. Effective cost reduction begins at the source and in the case of hospital systems, the operating room (OR). Taking this into consideration, administrators evaluating future revenue streams should look to consider OR-based cost reduction measures as part of their first step approach. Improving OR efficiency through block time and staff optimization remain the premise of today's existing literature on OR management strategies.

The Association of Anesthesia Clinical Directors (AACD) Glossary of Times Used for Scheduling and Monitoring of Diagnostic and Therapeutic Procedures.

The Glossary of Times Used for Scheduling and Monitoring of Diagnostic and Therapeutic Procedures also known as the Procedural Times Glossary (PTG) was originally developed with the support of the Association of Anesthesia Clinical Directors (AACD). The goal was to establish standardized terms to measure and assess the performance of operating room and procedural areas. By incorporating standardized concepts of efficiency and utilization, the PTG codified operating room metrics and facilitated benchmarking and quality improvement initiatives. In the last three decades, these concepts have also served as the basis for research in operating room management, including incorporating frameworks from diverse fields. The metrics in the PTG are divided into four categories: (1) Procedural Times; (2) Procedural and Scheduling Definitions and Time Periods; (3) Utilization and Efficiency Indices; and (4) Patient Categories. We describe each of the categories and corresponding metrics. The PTG provides the fundamental building blocks for managing operating and non-operating room suites. We hope that reintroducing these important time markers will help facilitate the reporting of standardized metrics.

Interdisciplinary Dialogue Is Needed When Defining Perioperative Recommendations: Conflicting Guidelines for Anesthetizing Patients for Pilonidal Surgery.

National or international guidelines can help surgeons and anesthesiologists make treatment decisions, but the existence of conflicting recommendations can hinder treatment rather than helping. A case in point is the treatment of pilonidal sinus disease, a chronic subcutaneous infection located in the sacrococcygeal area. Its incidence is rising, reaching almost 100/100,000 inhabitants. Three surgical societies have proposed guidelines for treating the disease, but these guidelines vary greatly in their approach to anesthesia. Who should provide input into guidelines? And how can medical disciplines successfully collaborate? Anesthesiologists must be involved in defining perioperative recommendations not only in patients with pilonidal sinus disease.

Demands of Integrated Care Delivery in Interventional Medicine and Anesthesiology: Interdisciplinary Teamwork and Strategy.

Evolving financial and medical constraints fueled by the increasing repertoire of nonoperating room cases and widening scope of patient comorbidities are discussed. The need to integrate finances and care approaches is detailed, and strategic suggestions for broader collaborative practice are suggested.

Value-Based Care and Strategic Priorities.

The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Once this analysis is completed, anesthesiologists must articulate their value to other medical professionals and to hospitals. Anesthesiologists can survive and thrive in a value-based health care environment if they are capable of providing services differently and able to deliver cost-effective care.

The future of nonoperating room anesthesia in the 21st century: emphasis on quality and safety.

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) has grown from an insignificant percentage of total anesthesia cases into a major percentage of anesthesia workload over the past 30 years. This trend evidences no signs of abating. RECENT FINDINGS: With the rapid development of novel interventional techniques in cardiology, radiology, gastroenterology and pulmonary medicine and other areas, the core responsibilities of the anesthesia provider will no longer be confined to delivering care in traditional operating rooms. This change presents challenges for the profession on several fronts. Efficient staffing of multiple locations poses challenges. The demand for anesthesia services continues to increase, but underutilization is a major problem. Each clinical area presents unique patient care issues. New interventional techniques are continually developed with which anesthesiologists need to be familiar in each specific area. NORA patients are older and medically complex, yet many are treated on an outpatient basis. Consequently, anesthetic management for NORA will of necessity require techniques that allow patients to recover quickly. SUMMARY: It may be anticipated that in the next decade that NORA cases will constitute over 50% of the number of cases performed with anesthesia involvement. As the last century belonged to invasive surgery, the next century will belong to interventionalists. There is also an increasing national emphasis on quality measurement and metrics reporting. Future anesthesia payment models under Medicare Access and CHIP Reauthorization Act, such as merit-based incentive payment system (MIPS), emphasize various process and outcomes measures. Anesthesiologists will be evaluated based on a composite performance score consisting of four components: quality, resource use, clinical practice improvement activities and meaningful use of certified electronic health record technology.

Operating Room Management at the Edge of Order and Chaos.

The operating room (OR) management literature tends to view management problems as having finite solutions and assumes that equilibrium exists in the intricate encounters that occur every day. In this article, we review complexity theory and assess its applicability to the strategic, tactical, and operational issues facing OR managers. By building on complexity theory and its assumptions, we also show that as complex systems, ORs resemble high-reliability organizations more than they resemble ultra-safe organizations. This distinction and the limitations of the current, linear modeling may have potential implications for the future of OR management research and practice. Opening the door to complexity, understanding the underpinnings of high-reliability organizations, and admitting that OR systems are complex adaptive systems, will lead to self-governing, transparent processes that envision the OR as a living, growing, sustainable human endeavor.