The purpose of this survey was to expand the limited knowledge regarding non-radiologist physician preferences in radiology report styles and content.

The Rural Trauma Team Development Course (RTTDC) is a one day course given to trauma personnel at various rural medical centers across the United States with the goal of improving care to injured patients in such areas. The purpose of this study is to determine the retention of RTTDC knowledge by those trained, as well as the migration rates of trainees out of these sites. The teaching of the RTTDC includes both pre‐test and post‐test assessments to ensure proper skills were learned. There was a statistically significant increase in score from the average course pre‐test score of 76.9% to the average course post‐test score of 92.1%. At this interim analysis, plotting the study post‐test scores over time since the course was given does reveal a pattern of decreased scores over time. The average study post‐test score of 88.8% is only slightly below the average initial post‐test score of 92.1%, though this was not significant. When assessed by individual questions, the participants scored significantly worse with questions addressing initial approach to the trauma patient and management of burn patients. There was no significant difference in scores between trauma team role. In this data set, the percentage of trainees remaining at course sites was 100%, though this was not expected based on previous studies. Our goal of 200 participants to achieve power has not been met at this time, but this could be established if more sites become involved, thus providing significant feedback for possible course revision.

Informant‐based assessments of cognition and function are commonly used to differentiate individuals with amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) from those who are cognitively normal (CN). However, determining the extent to which informant‐based measures correlate to objective neuropsychological tests is important given the widespread use of neuropsychological tests in making clinical diagnoses of aMCI and AD. The aim of the current study is to determine how well the Alzheimer’s Questionnaire (AQ) correlates with objective neuropsychological tests. Results showed that the AQ correlated strongly with the Mini Mental State Exam (r = ‐0.71) and the Mattis Dementia Rating Scale‐2 (r = ‐0.72), and moderate correlations were noted for the AQ with memory function (Rey Auditory Verbal Learning Test Delayed Recall, r = ‐0.61) and executive function (Trails B, r = 0.53). The AQ also correlated moderately with language function (Boston Naming Test 30‐Item, r = ‐0.44), but showed a weak correlation with visuospatial function (Judgment of Line Orientation, r = ‐0.28). The AQ also correlates particularly well with cognitive screens, showing the strongest correlations with the MMSE (r = ‐0.71) and the DRS‐2 (r = ‐0.72). The findings of this study suggest that the AQ correlates well with several neuropsychological tests, particularly those that assess the domains memory and executive function. These results lend further support to the validity of the AQ as a screening instrument for cognitive impairment as it correlates well with neuropsychological measures used to make clinical diagnoses of aMCI and AD.e sites become involved, thus providing significant feedback for possible course revision.

Background and Significance: The purpose of this study was to evaluate the effectiveness of the Barrow Brainbook (BBB) concussion education program as a tool to increase concussion knowledge among Arizona high school athletes and to modify attitudes and behaviors regarding concussion. Methods: This was a cross sectional study of Arizona high school athletes utilizing a 31 question multiple‐choice de‐identified survey. Attitude, knowledge, and behavior questions, as well as sport and level of participation were analyzed using the Wilcoxon Rank Sum test. Means between groups were analyzed using a two‐way ANOVA. Linear regression was used to determine if there was a relationship between number of years since completing BBB and concussion knowledge. Results: Surveys were distributed to 382 student athletes with 363 of those being completed. 224 students participated in BBB (62%). Knowledge and behaviors regarding concussion were not statistically significant when comparing students who had and had not participated in BBB. Those who participated in BBB scored more poorly on questions regarding attitudes about concussion than those who had not (p=0.033). Subsequent two‐way ANOVA testing showed that students who sustained a concussion scored worse (p<0.01) while completing BBB did not significantly affect attitude (p=0.399) when history of a concussion was brought in to the analysis. 90 students (25%) reported sustaining a concussion. Football and varsity level participation were significant for a higher mean number of concussions (p<0.05, p<0.05). There was no relationship between time since taking BBB and concussion knowledge (R2 was 0.007). Conclusions: In this study, there was no evidence to show that participating in the BBB program improved concussion knowledge, attitudes, or behaviors. Number of years since taking BBB was not a good predictor of concussion knowledge. Students who played football and participated at a varsity level were significantly more likely to sustain a concussion. Sustaining a concussion was associated with a higher attitude risk sum score. This is an evaluation of an educational tool specifically designed for adolescents that demonstrated no statistically significant change in increasing knowledge or modifying attitudes and behaviors in a population of high school athletes in Arizona.

Importance: This study proposed a new radiographic measure of obesity that is a better predictive indicator of obesity‐related risk: Fat/Bone Ratio. Primary Objective: Does the Fat/Bone Ratio correlate with obesity. Secondary Objective: Does the Fat/Bone Ratio correlate more closely with the comorbidities of obesity as compared to BMI. Design: Retrospective review of 2703 upright posterior‐anterior (PA) and lateral chest radiographs obtained from June 2013 through May 2014. The soft tissue height overlying the acromioclavicular joint was calculated and divided by the mid‐clavicle width to determine the Fat/Bone Ratio. Comorbidities of obesity were determined through chart review. Setting: Adult community emergency department. Participants: All adults (age greater than 18). Main Outcomes and Measures: BMI, Fat/Bone Ratio, comorbidities: hypertension, obstructive sleep apnea, osteoarthritis, hyperlipidemia, atherosclerosis, coronary artery disease, cerebrovascular accident, and myocardial infarction. Results: Fat‐to‐Bone ratio and BMI were both significantly associated with hypertension, diabetes, hyperlipidemia, obstructive sleep apnea, and osteoarthritis (P < .05). However, only Fat/Bone Ratio is associated with atherosclerosis (p = 0.02), coronary artery disease (p = 0.001), myocardial infarction (p = 0.002), and peripheral vascular disease (p = 0.01); BMI is not associated with these comorbidities (p = 0.90, 0.42, 0.25, and 0.50, respectively). Conclusions and Relevance: Findings suggest that Fat/Bone Ratio is an improved measure of obesity as compared to BMI.

Dysphagia with aspiration (DA) is the most common presenting symptom of patients at Phoenix Children’s Hospital’s Aerodigestive Clinic (ADC). Dysphagia with aspiration is associated with respiratory and gastrointestinal symptoms, chronic oral thickener use to prevent aspiration, secondary constipation, and occasionally, enteral tube dependency. MBS is considered the gold standard in instrumental assessment of dysphagia; it is used to evaluate severity and guide thickener treatment of DA patients, monitor progress with serial studies, and for re‐evaluation after intervention when appropriate. Previous evaluation of patients with deep interarytenoid notch given laryngoplasty injection included patients with improvement in symptoms despite post‐intervention MBS scores worsening, and vice versa, challenging the use of MBS as a longitudinal tool in clinical evaluation of patients with dysphagia and aspiration. Is MBS severity score reflective of clinical symptoms in pediatric patients with dysphagia and aspiration? A clinical questionnaire of DA symptoms was developed with input from the ADC physicians. The questionnaire was administered over 3 months to patients aged 1‐3 years who had an MBS evaluation within 6 months of their initial ADC visit, standard of care for patients with DA. 17 symptoms (12 GI and 5 pulmonary) were given a numerical score 0‐4 based on parent recall of frequency. MBS was scored 1‐10 on the thickness of liquid recommended for aspiration prevention. Individual symptoms and symptom sets (total questionnaire score, GI score, pulmonary score) were compared to MBS score using linear regression model. 30 patients were surveyed with median MBS score of 6 and range from 0 to 8. 18 patients had an MBS score above 6. Median questionnaire score was 18, with a range from 4 to 53. All analysis showed no significant correlation between individual symptoms or symptom sets and MBS score; the highest R2 value for any individual symptoms was 0.05. Among ADC patients with DA, MBS severity score did not correlate with severity or specificity of symptoms, questioning the use of MBS as a tool for diagnosing severity of persistent DA or as a repetitive tool in assessing response to laryngeal cleft surgical interventions and thickener wean therapy. These findings challenge the use of repetitive MBS in the ADC patient population. Our ultimate goal is to develop a combined clinical and radiologic tool that would minimize radiation exposure and unnecessary thickener treatment while promoting best clinical outcomes.

A detailed pre‐operative examination of a child’s neurovascular status following pediatric elbow fractures is critical to the assessment of these injuries. Without proper documentation of the preoperative exam, apparent postoperative changes in the neurovascular examination may be difficult to determine, and may dictate different treatment strategies. The reported incidence of neurologic (11.3%) and vascular (0.3‐4.6%) injury associated with supracondylar fractures underscores the importance of the preoperative exam. The purpose of this prospective study was to determine how frequently a complete neurovascular exam could be completed in children with elbow fractures. A detailed, specific elbow fracture History and Physical form was developed for prospective use on all pediatric elbow fractures in a tertiary care pediatric trauma hospital from 2013 through 2014. Specific neurovascular exam criteria were documented in an easily used checklist form. Demographic data collected included age, BMI, mechanism of injury, fracture type, comorbidities, pre‐operative pain management, and the operative procedure performed. There were 163 patients meeting the inclusion criteria. Attempted neurovascular (NV) exam was documented in 146 of these patients (89.6%). A clinically reliable, complete NV exam was possible in 104 patients (71.2%). In the remainder of the children, the clinician could not determine at least one aspect of the neurovascular exam. A significant correlation was found between age of the subject and ability to obtain a complete exam, with younger children less than age 5 being more likely to have incomplete information on the NV exam (p<0.000001). Gender, BMI, fracture type, pre‐assessment pain control, and potential language barriers had no effect on whether or not the exam was complete. Although a complete and detailed neurovascular examination is considered necessary when evaluating pediatric elbow fractures, over a fourth of our patients (29%) were unable to reliably participate in a full preoperative neurovascular exam. Younger children (less than 5 years of age) were less likely to participate in a complete neurovascular assessment. Neurovascular examinations in the setting of elbow fractures in children less than five years of age were unreliable and incomplete.

To analyze the roles of CCTA, MPI, and CC to formulate a sequential clinical algorithm to use in patients with chest pain, risk factors for CAD, and an abnormal EKG. The goals of the study are to streamline and refine workup, to decrease radiation exposure to patients, and to contain costs. 39 patients underwent CCTA, MPI, and CC within 30 months of each other. CCTA was used to categorize mild, moderate, or severe CAD. MPI used SSS, SDS, TID, and formal reading to define mild, moderate, or severe physiologic ischemia. CC and coronary intervention cine films were analyzed to define and treat anatomical CAD medically or by intervention. Results: There was strong correlation between CCTA, CC, and treatment type (p<0.0001). CCTA was able to stratify all patients with mild or severe ischemia to appropriate treatment groups, and to reduce the need for MPI. With moderate ischemia from CCTA, the additional use of MPI could have reduced the need for 16/18 (89%) patients who underwent CC to undergo further testing. No patients with mild or moderate CAD by CCTA, followed by mild to moderate physiologic ischemia by MPI, needed CC or intervention. 37/39 patients (95%) could have avoided one or more tests using our algorithm. CCTA followed by MPI may be used in symptomatic patients with risk factors for CAD and an abnormal EKG to stratify mild and moderate CAD, and to thereby avoid cardiac catheterization. Our algorithm could lead to savings in healthcare expenditures, save patients from unnecessary invasive procedures, decrease radiation exposure, and total cost.

Health literacy is the degree to which individuals have the capacity to understand basic health information and services needed to make appropriate health decisions. Women seen at Maricopa Integrated Health System (MIHS) Refugee Women’s Health Clinic (RWHC) are routinely offered education on developing a Reproductive Life Plan (RLP). In order to influence women’s reproductive health and medical decision‐making, there is a need to tailor RLP counseling to engage their male partners in the refugee community. We aimed to assess increased knowledge on preconception care related to the importance of developing a RLP, perspectives on birth spacing, and the influence of men as well as religion in medical decision‐making. We aimed to identify the refugee community’s receptivity to culturally and linguistically appropriate audiovisual modalities. Study participants comprised 120 refugees (39 men and 81 women) including couples, across the respective target languages with pre‐ and post‐Likert scale surveys assessing perspectives on RLP, birth spacing, the role of religion, and readiness for behavior change. Summary statistics examined changes in pre‐ and post‐Likert scale survey responses with responses dichotomized as Strongly agree/Agree compared against all other responses. A higher frequency of male respondents agreed about knowing what RLP means in the posttest relative to pretest (71.8% to 89.7%, P = 0.016) as well as 'Not having children…' (41% to 64.1%, P=0.035). Female respondents were more likely to agree to 'Know what RLP means' (76.5% to 86.4%, P =0.039) and 'Having a baby soon after…' (65.4% to 76.5%, P =0.035) after the training. They also were less likely to agree that 'RLP is about birth control' (71.6% to 59.3%, P =0.021). Amongst Muslim participants, we found improvement in knowing what RLP means (65.5% to 87.9%) and that it is important for men to have a RLP (67.2% to 84.5%). Cronbach’s alpha was used to measure internal inconsistency, with most values less than 0.5 and deemed unacceptable. Only one value, birth spacing, was > 0.6 and deemed questionable. There was the same degree of concordance, yet there also was discordance in the direction of opinions between women and men pre vs post‐test answers. When comparing couples pre and posttest, there was no significant differences observed across genders. This is the first reported U.S. initiative to provide a culturally and linguistically appropriate preconception health education. Project had demonstrated ability to mobilize several ethnic communities around the RLP. Respondents among both genders were more likely to agree about knowing what RLP means. The most challenging aspect of our community mobilization efforts was recruiting a larger sample size. Another limitation was the use of the Likert scale in a population with low literacy as there were some discrepancies in responses to negatively‐worded questions. Future studies could use a visual analog scale of smiley faces to assist those with limited literacy and incorporate a more global feel.

The cell make‐up and architecture of a wound is generally not explored before treatment is started. This pilot study will potentially be able to differentiate the histologic makeup of different wound etiologies and therefore start to elucidate a more targeted therapy to treat a wound with the hypothesis that etiology of wound is associated with a set of histologic characteristics. 12 samples of pressure wounds and 13 samples of autoimmune connective tissue wounds were examined and characterized under microscopy. Types of cells, necrosis, granulation, and inflammation, among other characteristics were studied. The autoimmune wounds displayed a statistically significant increase in lymphocytes, chronic inflammation, and fibrosis than in the pressure wounds. There are apparent differences in histology and morphology of wounds of different etiologies, as hypothesized. This suggests the possibility of requiring specific treatments for the varying wound types.