Medicine
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To evaluate the diagnostic efficiency of computer-aided diagnosis (CAD) system and 111 radiologists with different experience in identifying benign and malignant thyroid nodules, and to summarize the ultrasound features that may affect the diagnostic of CAD and radiologists. Fifty thyroid nodules and 111 radiologists were enrolled in this study. All the 50 nodules were diagnosed by the 111 radiologists and the CAD system simultaneously. ⋯ The CAD system achieved equal diagnostic accuracy to the senior radiologists and higher accuracy than the junior radiologists. The interobserver agreements in the US features between the CAD system and senior radiologist were substantial agreement for hypoechoic and taller than wide; moderate agreement for irregular margin and micro-calcifications. The location of a thyroid nodule and the feature of macrocalcification with wide acoustic shadow may influence the analysis of the CAD system.
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An axial-volume scan with adaptive statistical iterative reconstruction-V (ASIR-V) is newly developed. Our goal was to identify the influence of axial-volume scan and ASIR-V on accuracy of automated nodule volumetry. An "adult' chest phantom containing various nodules was scanned using both helical and axial-volume modes at different dose settings using 256-slice CT. ⋯ The axial-volume scan reduced radiation dose by 19.7% compared with helical scan at all radiation dose settings without affecting the accuracy of nodule volumetric measurement (P = .375). Image noise, CNR, and SNR were not significantly different between two scan modes (all, P > .05). The use of axial-volume scan with ASIR-V achieved effective radiation dose reduction while preserving the accuracy of nodule volumetry.
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Observational Study
Fixed effects analysis of the incidence of cardiovascular outcomes under managed care following the managed care backlash.
To examine the impact of increased managed care activity on 30-day readmission and mortality for acute myocardial infarctions and congestive heart failure in U. S. hospitals following the managed care backlash against managed care cost containment practices. The Centers for Medicare and Medicaid Services (CMS) Hospital Compare files, CMS Hospital Cost Report, CMS Medicare Advantage Enrollment files, and Health Resources and Services Administration Area Resource File data for the period 2008 to 2011 were used to construct the study sample. ⋯ All hospital types reported similar congestive heart failure trends as the full sample; however, proprietary hospitals reported greater declines in readmission and mortality. Increased managed care activity is associated with reductions in hospital readmission and mortality following the legislative and consumer backlash against managed care, with differential impacts across hospital ownership type. These finding highlights the important role of managed care in creating quality improvements in the delivery of care in the hospital setting.