Purpose Computed tomography (CT) examinations, often using high-radiation dosages, are increasingly used in the acute management of polytrauma patients. This study compares a low-dose polytrauma multi-phase whole-body CT (WBCT) protocol on a latest generation of 16-cm detector 258-slice multi-detector CT (MDCT) scanner with advanced dose reduction techniques to a single-phase polytrauma WBCT protocol on a 64-slice MDCT scanner. Methods Between March and September 2015, 109 polytrauma patients (group A) underwent acute WBCT with a low-dose multi-phase WBCT protocol on a 258-slice MDCT whereas 110 polytrauma patients (group B) underwent single-phase trauma CT on a 64-slice MDCT. The diagnostic accuracy to trauma-related injuries, radiation dose, quantitative and semiquantitative image quality parameters, subjective image quality scorings, and workflow time parameters were compared. Results In group A, statistically significantly more arterial injuries (p = 0.04) and arterial dissections (p = 0.002) were detected. In group A, the mean (±SD) dose length product value was 1681 ± 183 mGy*cm and markedly lower when compared to group B (p < 0.001). The SDs of the mean Houndsfield unit values of the brain, liver, and abdominal aorta were lower in group A (p < 0.001). Mean signal-tonoise ratios (SNRs) for the brain, liver, and abdominal aorta were significantly higher in group A (p < 0.001). Group A had significantly higher image quality scores for all analyzed anatomical locations (p < 0.02). However, the mean time from patient registration until completion of examination was significantly longer for group A (p < 0.001). Conclusions The low-dose multi-phase CT protocol improves diagnostic accuracy and image quality at markedly reduced radiation. However, due to technical complexities and surplus electronic data provided by the newer low-dose technique, examination time increases, which reduces workflow in acute emergency situations.
Background: Healthcare managers are expected to lead and manage planned organizational change intended to improve healthcare process quality. However, their complex working conditions offer limited decision control, and healthcare managers often feel ill prepared and inadequately supported to perform their duties. Healthcare managers have previously described their need for organizational support, but we lack knowledge of the preconditions and resources that help managers implement planned change.Methods: This prospective cohort study examined healthcare managers at three Swedish hospitals implementing lean production and two Swedish hospitals implementing their own improvement model. Questionnaire data from 2012, 2103, and 2014 were used in following up. We used t-tests and a linear mixed model design in analysing the data. Results: Healthcare managers who perceived strong support from managers, employees, colleagues, and the organization and managers with the longest managerial experience had the least negative appraisal of change. Managers who perceived strong support from employees, management, and the organizational structure perceived higher levels of healthcare process quality. Conclusions: Long managerial experience and strong support from managers, employees, and the organization are important for managers' appraisal of, work on, and successful implementation of planned change. Top management must therefore ensure that the healthcare managers have sufficient managerial experience and support before they delegate to them the responsibility to implement planned change.
Purpose of the Review The review synthesises the current knowledge of post-windstorm management in selected European countries in order to identify knowledge gaps and guide future research. Recent Findings Despite the differences in forest ownership and national regulations, management experiences in Europe converge at (1) the need for mechanization of post-windthrow management to ensure operator safety, (2) the importance to promote operator training and optimise the coordination between all the actors involved in disturbance management and (3) the need to implement measures to consolidate the timber market while restoring forest ecosystem services and maintain biodiversity. Summary Windstorms are natural disturbances that drive forest dynamics but also result in socio-economic losses. As the frequency and magnitude of wind disturbances will likely increase in the future, improved disturbance management is needed. We here highlight the best practices and remaining challenges regarding the strategic, operational, economic and environmental dimensions of post-windthrow management in Europe. Our literature review underlined that post-disturbance management needs to be tailored to each individual situation, taking into account the type of forest, site conditions, available resources and respective legislations. The perspectives on windthrown timber differ throughout Europe, ranging from leaving trees on site to storing them in sophisticated wet storage facilities. Salvage logging is considered important in forests susceptible to bark beetle outbreaks, while no salvage logging is recommended in forests protecting against natural hazards. Remaining research gaps include questions of balancing between the positive and negative effects of salvage logging and integrating climate change considerations more explicitly in post-windthrow management.
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