Snapshot of current carotid artery stenting practice and accreditation in the USA.

OBJECTIVE: The aim of this exploratory study was to compare the performance of carotid artery stenting (CAS) best practices between Intersocietal Accreditation Commission (IAC) accredited facilities and non-accredited facilities certified by the Centers for Medicare and Medicaid Services (CMS). METHODS: A random, anonymous survey was sent to CMS and IAC accredited facilities querying facility routine performance of 16 CAS procedure components found in published guidelines and utilised during clinical trials. RESULTS: There were 28 responses (response rate=17%). Significant differences were found between the CMS and the IAC facilities for four of 16 procedure measures: determination of modified Rankin Scale score prior to stenting (p=0.012, 95% CI 20% to 80%), accurate measurement of per cent stenosis using electronic callipers (p=0.005, 95% CI 24% to 84%), confirmation of anticoagulation with activated clotting time greater than 250 s prior to crossing the lesion (p=0.03, 95% CI 7% to 69%), and comparison of facility outcomes to accepted benchmarks for stroke and death (p=0.03, 95% CI 7% to 69%). Overall, IAC facilities performed all 16 procedures more frequently (97%) than CMS facilities (66%) (p<0.001, 95% CI 24% to 36%). CONCLUSIONS: Although the sample size was small, the results demonstrated IAC accredited facilities are more likely to follow best practices, to use quantitative tools to select appropriate patients, and quantitively measure patient-centred clinical outcomes compared with CMS certified facilities. The findings raise the question as to the value of CMS certification versus IAC accreditation as a requirement for reimbursement.

Effect of Facility IAC-Accreditation on CT Dose Awareness and Reduction.

PURPOSE: To assess characteristics of computed tomography (CT) facilities accredited by the Intersocietal Accreditation Commission (IAC) and evaluate the perceived effect of accreditation on CT radiation dose awareness and reduction. METHODS: IAC-accredited CT facilities were sent a survey in April 2016, which included 20 questions categorized into 5 groups: equipment and facility (7), patient safety/practice (5), protocols (2), dose reduction practice (3), and quality improvement (3). RESULTS: The response rate was 20.7% (N = 607). A majority of facilities (80%) reported that radiation dose was adjusted based on patient size. Before undergoing accreditation, 79% of facilities reported annual review of CT protocols and radiation exposure. Following accreditation, that number increased to 93%. A majority (77%) of respondents indicated that the accreditation process, along with the IAC Standards and Guidelines, increased awareness of radiation exposure; in addition, 36% indicated that radiation doses were lower after undertaking accreditation. DISCUSSION: This study demonstrated that most IAC-accredited facilities followed recommended radiation safety practices by adjusting radiation dose based on patient size, reviewing protocols annually, and participating in quality improvement activities that focus on patient radiation exposure. CONCLUSION: IAC-accredited facilities reported that the accreditation process had a positive effect on radiation dose awareness and reduced dose associated with CT examinations.

A randomized trial of transcutaneous electric acupoint stimulation as adjunctive treatment for opioid detoxification.

This pilot study tested the effectiveness of transcutaneous electric acupoint stimulation (TEAS) as an adjunctive treatment for inpatients receiving opioid detoxification with buprenorphine-naloxone at a private psychiatric hospital. Participants (N = 48) were randomly assigned to active or sham TEAS and received three 30-minute treatments daily for 3 to 4 days. In active TEAS, current was set to maximal tolerable intensity (8-15 mA); in sham TEAS, it was set to 1 mA. By 2 weeks postdischarge, participants in active TEAS were less likely to have used any drugs (35% vs. 77%, p < .05). They also reported greater improvements in pain interference (F = 4.52, p < .05) and physical health (F = 4.84, p < .01) over time. TEAS is an acceptable, inexpensive adjunctive treatment that is feasible to implement on an inpatient unit and may be a beneficial adjunct to pharmacological treatments for opioid detoxification.

Training physicians for combat casualty care on the modern battlefield.

INTRODUCTION: Trauma training among nonsurgical physicians in the military is highly variable in amount and quality. However, all deployed military physicians, regardless of specialty, are expected to provide combat casualty care. The goal was to assess the effectiveness of an intense modular trauma refresher course for nonsurgical physicians deploying to a combat zone. METHODS: All graduating nonsurgical residents participated in this 2.5-day course, consisting of 4 modules: (1) didactic session; (2) simulation with interactive human surgical simulators; (3) case presentations and triage scenarios from Iraq/Afghanistan with associated skill stations; and (4) live tissue surgical procedure laboratory. Competency tests, surveys, and after action comments were reviewed and compared before and after course completion. RESULTS: Between May 2005 and April 2007, 60 physicians participated in the course. By specialties, there were 32 internists, 16 pediatricians, 7 general practitioners, 4 obstetricians/gynecologists, and 1 "other" nonsurgical physician represented. Precourse and postcourse tests were administered to 31 of 60 participants. The mean test scores improved from 76% to 96% upon completion of the course (p < 0.01). Additionally, self-perceived confidence levels in handling battlefield casualties from questionnaires based on Likert scale responses (1 = not confident, 5 = confident) improved from an average of 2.3 before the course to 3.9 upon completion of the course (p < 0.01). CONCLUSION: All military physicians must be prepared to manage combat casualties. This hybrid training model may be an effective method to prepare nonsurgeons to deal with battle injuries. This course significantly improved the knowledge and confidence among primary care physicians.

Mild traumatic brain injury in psychiatric inpatients.

The purpose of this study was to compare psychiatric inpatients with and without mild traumatic brain injury (MTBI) on the variables of length of stay (LOS), number of psychiatric admissions, and change from admission to discharge on Global Assessment of Functioning (GAF). The study sample included 54 psychiatric inpatients, 18 to 65 years old, with a history of MTBI and 52 comparison psychiatric inpatients absent histories of MTBI, matched on age, sex and diagnostic category. LOS was longer for those with MTBI than for those without MTBI. This difference was statistically significant, after adjustment for matching. When adjusted for baseline GAF, this LOS difference remained statistically significant. The number of prior psychiatric admissions was 19% higher for participants with MTBI than for comparison participants, and when the LOS analysis was adjusted for this factor, it remained statistically significant. GAF change-from-baseline did not differ between the MTBI and comparison groups. Data from this study suggest that psychiatric inpatients with a history of MTBI may differ in frequency and length of hospitalization from otherwise similar inpatients without MTBI history.

Staff & client perceptions of unit quality: a pilot study.

This pilot study compared psychiatric health care team members' perceptions of unit quality with discharged clients' perceptions of quality of care received on the unit. The staff members were from four different service units in one acute care psychiatric facility. The study used the Perceptions of Unit Quality (PUQ) scale, a valid and reliable outcome measurement instrument, developed by Cronenwett. Most quality assurance instruments that exist have focused on individual caregivers' or service-specific views of quality, but the PUQ scale allows quality assurance data that represent team performance to be described through team perceptions of quality. Results of this pilot study suggest that use of the PUQ scale, in conjunction with clients' perceptions of unit quality, may be a legitimate approach in continuous quality improvement efforts in psychiatric-mental health care centers.