Jim Y Wan

The University of Tennessee Health Science Center, Memphis, Tennessee, United States

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Publications (120)402.49 Total impact

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    ABSTRACT: Women with primary provoked vestibulodynia experience greater experimentally induced pain than do women with secondary provoked vestibulodynia. We determined whether central sensitization is a contributing factor by measuring cutaneous response to capsaicin, controlling for ethnic differences observed with chronic pain. Twenty-nine women with primary vestibulodynia and 28 women with secondary provoked vestibulodynia underwent intradermal injection in the forearm. Outcome measures included spontaneous pain level (0-100 numeric rating scale) and surface areas of punctate hyperalgesia (cm) and dynamic allodynia (cm). Two-way ANOVA was performed with Bonferroni correction (P=.01). Women with primary provoked vestibulodynia did not experience greater spontaneous pain (82.1±9.1 compared with 84.1±9.1, P=.63), hyperalgesia (24.1±3.8 compared with 18.2±3.4, P=.28), or allodynia (8.8±1.6 compared with 6.4±1.4, P=.39) than women with secondary provoked vestibulodynia. Black women with provoked vestibulodynia reported more spontaneous pain (91.5±8.8 compared with 65.9±8.7, P=.03), hyperalgesia (25.2±3.8 compared with 14.6±2.6, P=.07), and allodynia (9.3±1.6 compared with 5.0±0.8, P=.06) than white women, though not at .01. No interaction effects were observed for spontaneous pain (P=.30). Ethnicity but not provoked vestibulodynia subtype may affect capsaicin-induced pain. Altered pain perception in women with primary vestibulodynia may be related to mechanisms other than central sensitization. Centrally mediated C-fibers may be related to the pain intensity observed in black women with provoked vestibulodynia.
    Obstetrics and Gynecology 05/2015; 125 Suppl 1:22S. DOI:10.1097/01.AOG.0000465326.78400.1e · 4.37 Impact Factor
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    ABSTRACT: Although there is an increasing body of evidence regarding successful recruitment in clinical trials, limited data are available on the influence of gender, ethnicity, or specific gynecologic conditions. Recruiting women with provoked vestibulodynia is particularly challenging owing to reluctance in discussing dyspareunia. Recruitment methods for patients with provoked vestibulodynia were analyzed for efficacy, cost, and ethnicity preferences. Recruitment included mass mailing (mailing house, utilities company), media (web site development, Facebook, Craigslist, newspaper advertisements, flyers, newsletters), community outreach (presentations, community events), and the health care system (clinician letters, clinic patients, registry). Data were analyzed by χ, ANOVA, and a logistic model. Among 503 inquiries, 134 patients were eligible (26.6%) and 58 (11.5%) were randomized. Patients recruited through the health care system were significantly more likely to be eligible (38%) than those recruited through mass mailing (25%) or the media (20%) (P<.003). Neither recruitment method (P=.64) nor ethnicity (P=.19) had any effect on randomization, and there were no interaction effects between recruitment method and ethnicity (P=.96). Community outreach appears ineffective. Cost per randomized patient was $525, $527, and $17 for mass mailing, media, and health care system, respectively. The health care system is the most efficient and cost-effective recruitment method; it does not lead to more randomized patients or reach more minority women with provoked vestibulodynia. Specific methods for improving randomization rates and increasing minority enrollment are needed.
    Obstetrics and Gynecology 05/2015; 125 Suppl 1:22S. DOI:10.1097/AOG.0000000000000752 · 4.37 Impact Factor
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    ABSTRACT: Cigarette smoking is known to increase perioperative complication rates, but no study to date has examined its effect specifically in forefoot surgery. The purpose of this study was to determine whether cigarette smoking increased complications after forefoot surgery. The records of 602 patients who had forefoot surgery between 2008 and 2010, and for whom smoking status was known, were reviewed. Patients were categorized into 3 groups based on smoking status: active smoker, smoker in the past, or nonsmoker. Medical records were reviewed for occurrence of complications, including nonunion, delayed union, delayed wound healing, infection, and persistent pain. Active smokers were found to have a notably higher complication rate (36.4%) after forefoot surgery than patients who previously (16.5%) or never (8.5%) smoked. Patients who continued to smoke in the perioperative period had the highest percentage of delayed union (3.0%), infection (9.1%), delayed wound healing (10.6%), and persistent pain (15.2%). Active cigarette smokers were 4.3 times more likely to have a complication than nonsmokers. Patients who smoked at any point in the past but quit prior to surgery were 1.9 times more likely than nonsmokers to incur a complication. The average time of smoking cessation for patients who had smoked at any point in the past but had quit prior to surgery was 17 years. For active smokers, those with a complication smoked an average of 18 cigarettes daily, while those without a complication smoked 14 cigarettes daily. Before forefoot surgery, surgeons should educate patients who smoke about their increased risk of complications and encourage smoking cessation. Level III, retrospective comparative study. © The Author(s) 2015.
    Foot & Ankle International 01/2015; DOI:10.1177/1071100714565785 · 1.63 Impact Factor
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    ABSTRACT: Objective: To study the association of a multimodal pain protocol (MMPC) and reduced hospital stay after open abdominal hysterectomy. Study design: The study design was a comparison of a prospective cohort with a retrospective historical control. We enrolled endometrial cancer patients undergoing open abdominal hysterectomy with lymphadenectomy by the same surgeon. Control patients from 2008 to 2010 who received morphine PCA alone were compared with a similar demographic group of patients from 2011 to 2013 who received MMPC. MMPC consisted of gabapentin (900 mg PO) and acetaminophen (1 g IV) administered 45-60 min preoperatively. The surgical site was injected with bupivacaine with 0.5% epinephrine prior to incision. The postoperative pain control regimen consisted of gabapentin (300 mg PO every 6 h), acetaminophen (1 g IV every 8 h for 24 h postoperatively), ketorolac (15 mg IV every 6 h for 48 h postoperatively), morphine PCA (2 mg IV every 10 min, no basal rate) and oxycodone/acetaminophen (10/325 mg PO every 6 h as needed). Results: Length of hospital stay (LOH) of the study cohort (N = 105 with MMPC) was compared with the historical with postoperative morphine alone (N = 113 without MMPC). There were no differences in demographic, uterine cancer stage, or comorbidities between the two arms. The LOH was 1.6 days for patients receiving MMPC and 3.3 days for patients who received morphine alone (P < 0.001). Conclusion: Multimodal pain control is associated with significantly reduced hospital stay after open abdominal hysterectomy.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 12/2014; 183. DOI:10.1016/j.ejogrb.2014.10.007 · 1.63 Impact Factor
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    ABSTRACT: Objectives: Determine whether the implementation of the Medicare Part D 2006 was associated with changes in differential racial and ethnic disparity patterns between the individuals ineligible for medication therapy management (MTM) services and MTM-eligible individuals. The urgency for modifying MTM eligibility criteria would be increased if the reduction of disparity not seen. Methods: Data from the Medicare Current Beneficiary Survey were analyzed. A difference-in-differences analyses, difference-in-differences-in-differences-in-differences (DDDD) model, was used to examine changes in difference in disparities between the MTM-ineligible and MTM-eligible individuals from 2004-2005 to 2007-2008 in relation to the changes from 2001-2002 to 2004-2005. Disparities were examined in health outcomes, health services utilizations/costs, and medication utilization. Both main and sensitivity analyses were conducted by various regression models. Findings: The main analysis found no significant DDDD values. For racial disparities, according to some sensitivity analyses, Part D implementation was associated with a reduction in greater racial disparities among the MTM-ineligible and MTM-eligible individuals in activities of daily living (DDDD=1.13; P=0.03 for one analysis) and instrumental activities of daily living (DDDD=0.95; P=0.03 for one analysis). For ethnic disparities, Part D implementation was associated with reduction in any greater disparities among the MTM-ineligible than MTM-eligible individuals in costs of physician visits (DDDD=-4613.71; P=0.04 for one analysis) and high risk medication utilization (DDDD=-0.10; P=0.03 for one analysis). Conclusions: Part D implementation is not consistently associated with reductions in the disparity implications of the Medicare MTM eligibility criteria. The MTM eligibility criteria need to be modified in order to eliminate their disparity implications.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Motor slowing and forebrain white matter loss have been reported in premanifest Huntington's disease (HD) prior to substantial striatal neuron loss. These findings raise the possibility that early motor defects in HD may be related to loss of excitatory input to striatum. In a prior study, we showed that in the heterozygous Q140 knock-in mouse model of HD that loss of thalamostriatal axospinous terminals is evident by 4 months, and loss of corticostriatal axospinous terminals is evident at 12 months, before striatal projection neuron pathology. In the present study, we specifically characterized the loss of thalamostriatal and corticostriatal terminals on direct (dSPN) and indirect (iSPN) pathway striatal projection neurons, using immunolabeling to identify thalamostriatal (VGLUT2+) and corticostriatal (VGLUT1+) axospinous terminals, and D1 receptor immunolabeling to distinguish dSPN (D1+) and iSPN (D1-) synaptic targets. We found that the loss of corticostriatal terminals at 12 months of age was preferential for D1+ spines, and especially involved smaller terminals, presumptively of the intratelencephalically projecting (IT) type. By contrast, indirect pathway D1- spines showed little loss of axospinous terminals at the same age. Thalamostriatal terminal loss was comparable for D1+ and D1- spines at both 4 and 12 months. Regression analysis showed that the loss of VGLUT1+ terminals on D1+ spines was correlated with a slight decline in open field motor parameters at 12 months. Our overall results raise the possibility that differential thalamic and cortical input loss to SPNs is an early event in human HD, with cortical loss to dSPNs in particular contributing to premanifest motor slowing.
    Frontiers in Systems Neuroscience 10/2014; 8:198. DOI:10.3389/fnsys.2014.00198
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    ABSTRACT: This study aimed to collect preliminary evidence on the efficacy of milnacipran in reducing pain in women with provoked vestibulodynia (PVD) and to identify which patient characteristics predict treatment success.
    Journal of Lower Genital Tract Disease 08/2014; DOI:10.1097/LGT.0000000000000057 · 1.11 Impact Factor
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    ABSTRACT: Objective Medication therapy management (MTM) has the potential to play an instrumental role in reducing racial and ethnic disparities in health care. However, previous research has found that blacks and Hispanics are less likely to be eligible for MTM. The purpose of the current study was to examine the potential effects of MTM eligibility criteria on racial and ethnic disparities in health outcomes.Methods The current study is a retrospective cross-sectional analysis of the Medicare Current Beneficiary Survey Cost and Use files for the years 2007 and 2008. A difference-in-differences model was used to compare disparities in outcomes between ineligible and eligible beneficiaries according to MTM eligibility criteria in 2010. This was achieved by including in regression models interaction terms between dummy variables for blacks/Hispanics and MTM eligibility criteria. Interaction terms were interpreted on both multiplicative and additive terms. Various regression models were used depending on the types of variables.Key findingsWhites were more likely to report self-perceived good health status than blacks and Hispanics among both MTM-eligible and MTM-ineligible populations. Disparities were greater among MTM-ineligible than MTM-eligible populations (e.g. on additive term, difference in odds = 1.94 and P < 0.01 for whites and blacks; difference in odds = 2.86 and P < 0.01 for whites and Hispanics). A few other measures also exhibited significant patterns.ConclusionsMTM eligibility criteria may exacerbate racial and ethnic disparities in health status and some measures of health services utilizations and costs and medication utilization. Future research should examine strategies to remediate the effects of MTM eligibility criteria on disparities.
    06/2014; 5(2). DOI:10.1111/jphs.12055
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    ABSTRACT: Objective A hemoglobin (Hb) A1c range of 5.7%-6.4% has been recommended for the diagnosis of prediabetes. To determine the significance of such “prediabetic” HbA1c levels, we compared glucoregulatory function in persons with HbA1c levels of 5.7%-6.4% and those with HbA1c < 5.7%. Methods We studied 280 nondiabetic adults (142 black, 138 white; mean (± SD) age 44.2 ± 10.6 y). Each subject underwent clinical assessment, blood sampling for HbA1c measurement, and a 75-g oral glucose tolerance test at baseline. Additional assessments during subsequent outpatient visits included insulin sensitivity, using homeostasis model assessment (HOMA)-IR and the hyperinsulinemic euglycemic clamp; insulin secretion, using HOMA-B and frequently samples intravenous glucose tolerance test (FSIVGTT) and disposition index (DI); and measurement of fat mass, using DXA. Results Compared to subjects with HbA1c < 5.7%, persons with HbA1c levels of 5.7%- 6.4% were older, and had higher body mass index (BMI) and insulin secretion but similar insulin sensitivity. When the two groups were matched in age and BMI, persons with HbA1c 5.7-6.4% were indistinguishable from those with HbA1c < 5.7% with regard to all measures of glycemia glucoregulatory function. Conclusions: Unlike glucose-defined prediabetes status, an HbA1c range of 5.7%- 6.4% does not reliably identify individuals with impaired insulin action or secretion, the classical defects underlying the pathophysiology of prediabetes. Thus, HbA1c cannot validly replace blood glucose measurement in the diagnosis of prediabetes. If utilized as a screening test due to convenience, aberrant HbA1c values should be corroborated with blood glucose measurement before therapeutic intervention.
    Metabolism: clinical and experimental 06/2014; DOI:10.1016/j.metabol.2014.03.002 · 3.61 Impact Factor
  • Value in Health 05/2014; 17(3):A153. DOI:10.1016/j.jval.2014.03.892 · 2.89 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e385. DOI:10.1016/j.juro.2014.02.1081 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e486. DOI:10.1016/j.juro.2014.02.1147 · 3.75 Impact Factor
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    ABSTRACT: Background: Whilst the incidence of type 2 diabetes (T2D) among persons with prediabetes is well-known (∼10%/year), the incidence of prediabetes among normoglycemic persons is unclear. Also, in the Diabetes Prevention Program, no racial/ethnic differences were seen in diabetes incidence, whereas marked racial/ethnic disparities are reported in the prevalence of T2D. We aimed to obtain estimates of incident prediabetes, and determine whether racial disparities manifest during transition to prediabetes. Design and Methods: We enrolled 376 (217 black, 159 white) non-diabetic offspring of parents with T2D (mean age 44.2 years), and followed them quarterly for 5.5 years. Assessments included anthropometry, body composition, OGTT, biochemistries, energy expenditure, insulin sensitivity, and insulin secretion. The primary outcome was progression to impaired fasting glucose and/or impaired glucose tolerance (or diabetes). Results: Of 343 participants with evaluable data, 101 subjects (49 white, 52 black) developed prediabetes and 10 (4 white, 6 black) developed diabetes during a mean follow-up of 2.62 years. There was no significant racial difference in the cumulative incidence of prediabetes (White 32.7%, Black 30%) or combined prediabetes/diabetes (White 35%, Black 30%). Significant predictors of prediabetes included age, gender, trunk fat, 2hr post-load glucose (2hrPG), insulin sensitivity, and insulin secretion. In a Cox proportional-hazards model, with adjustment for age and sex, the 2hrPG and abdominal obesity were independent predictors of incident prediabetes/diabetes (relative hazards [95% CI] for 90th vs. 10th percentile: trunk fat mass 2.90 [1.74-4.82], P<0.0001; 2hrPG 2.54 [1.46-4.40], P=0.0009. Having trunk fat mass and 2hrPG at the 90th percentile conferred a 7-fold hazard of prediabetes compared to persons at the 10th percentile for both measures. Conclusion: Black and white offspring of parents with type 2 diabetes develop prediabetes at a similar high rate of ∼11% per year. Therefore, close surveillance, with prompt intervention to prevent dysglycemia, is warranted in persons with parental diabetes.
    The Journal of Clinical Endocrinology and Metabolism 03/2014; 99(6):jc20141077. DOI:10.1210/jc.2014-1077 · 6.31 Impact Factor
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    ABSTRACT: Objective To examine incidence of and risk factors for development of hyperlipidemia (HL) in patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for renal cortical neoplasms, as HL is a major source of morbidity in chronic kidney disease (CKD).Patients and Methods Two-center retrospective analysis of 905 patients (mean age 57.5 years, mean follow-up 78 months) who underwent RN (610) or PN (295) from 7/1987-6/2007. Demographics, preoperative and postoperative HL were recorded. De novo HL was defined ≥6 months after surgery with laboratory values meeting National Cholesterol Education Program ATP III definitions. Kaplan-Meier method was used to assess freedom from de novo HL. Multivariable analysis (MVA) was conducted to elucidate risk factors for de novo HL.ResultsThere were no significant differences with respect to demographics, preoperative GFR<60 (p=0.123) and HL (p=0.144). Tumor size (cm) was significantly larger for RN (7.0 vs. PN 3.7, p<0.001). Significantly greater postoperative GFR<60 was noted in RN (45.7% vs. PN 18%, p<0.001). Significantly more de novo HL developed in RN (23% vs. PN 6.4%, p<0.001). Mean time to development of HL was longer for PN (54 vs. RN 44 months, p=0.03). Five-year freedom from de novo HL probability was 76% RN vs. 96% PN (p<0.001). MVA demonstrated RN (OR 2.93, p=0.0107), preoperative (OR 1.98, p=0.037) and postoperative (OR 7.89, p<0.001) GFR<60 as factors associated with HL development.Conclusion Patients who underwent RN had significantly higher incidence and shorter time to development of de novo HL. RN, preoperative and postoperative eGFR<60 were associated with development of HL. Further follow-up and prospective investigation is necessary to confirm these findings.
    BJU International 03/2014; 114(6). DOI:10.1111/bju.12744 · 3.13 Impact Factor
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    ABSTRACT: Intradermally injected capsaicin has been used extensively both as a human pain model and to assess analgesic efficacy. Factors such as dose, formulation, route, and site are known to affect its sensitivity. We determined whether potency and stability of capsaicin solutions were further sources of variability when following strict manufacturing guidelines. Capsaicin solution (1.0 mg/mL) was prepared according to Current Good Manufacturing Practice (cGMP) guidelines and aseptically filled into sterile amber borosilicate vials and stored at 5°C, 25°C, and 30°C. All samples were analyzed at one, three, six, and twelve months. Chemical stability was determined using HPLC and physical stability was evaluated by visual inspection of color changes, clarity, particulate matter, and product/ container closure abnormalities during each sampling time. Capsaicin intradermal injection was found to be sterile and retained 95% of the initial concentration for at least one year, regardless of studied storage temperatures (P<0.0001). Visual inspection indicated no changes in color, clarity, particulate matter, and product/ container closure abnormalities in all samples. These data show that capsaicin solutions (1.0 mg/mL) maintain their potency and stability over one year when manufactured according to cGMP guidelines. These results suggest that in clinical trials manufacturing of capsaicin solutions is recommended over extemporaneous compounding.
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    ABSTRACT: Objective. To assess the risk of classical hysterotomy and surgical morbidity among women with a body mass index (BMI) greater than 40 kg/m(2) who underwent a supraumbilical incision at the time of cesarean delivery. Methods. We conducted a retrospective cohort study in women having a BMI greater than 40 kg/m(2) who underwent a cesarean delivery of a live, singleton pregnancy from 2007 to 2011 at a single tertiary care institution. Intraoperative and postoperative outcomes were compared between patients undergoing supraumbilical vertical (cohort, n = 45) or Pfannenstiel (controls, n = 90) skin incisions. Results. Women undergoing supraumbilical incisions had a higher risk of classical hysterotomy (OR, 24.6; 95% CI, 9.0-66.8), surgical drain placement (OR, 6.5; 95% CI, 2.6-16.2), estimated blood loss greater than 1 liter (OR, 3.4; 95% CI, 1.4-8.4), and longer operative time (97 ± 38 minutes versus 68 ± 30 minutes; P < .001) when compared to subjects with Pfannenstiel incisions (controls). There was no difference in the risk of wound complication between women undergoing supraumbilical or Pfannenstiel incisions (OR, 2.7; 95% CI, 0.9-8.0). Conclusion. In women with a BMI above 40 kg/m(2), supraumbilical incision at the time of cesarean delivery is associated with a greater risk of classical hysterotomy and operative morbidity.
    Journal of pregnancy 11/2013; 2013:890296. DOI:10.1155/2013/890296
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    ABSTRACT: Objective: Initial assessment of metabolic acidosis in subjects with diabetic ketoacidosis (DKA) is performed using arterial blood gas analysis. This process is expensive, painful and technically difficult. Furthermore, blood gas analysis may not be available in some facilities especially in developing countries where the morbidity and mortality from DKA remain high. Therefore we investigated the utility of venous bicarbonate concentration obtained from basic metabolic panel in predicting arterial pH in adults with DKA.Methods: We performed a retrospective analysis of clinical and biochemical data of 396 adults admitted with DKA in two community teaching hospitals. We determined the correlation between arterial pH and venous serum parameters. Using multiple logistic regression module we obtained a predictive formula for arterial pH from serum venous bicarbonate level.Results: The patient population was composed of 59.0% males and had mean age of 36.7 ± 13.3 years. We derived that arterial pH = 6.97 + (0.0163 x bicarbonate); applying this equation, we determined that serum venous bicarbonate concentration of ≤ 20.6 mEq/L predicted arterial pH of ≤ 7.3 with over 95% sensitivity and 92% accuracy.Conclusion: Venous serum bicarbonate obtained from the basic metabolic panel proved to be an affordable and reliable way of estimating arterial pH in adults with DKA. Validation of this formula in a prospective study would offer a more accessible means of estimating metabolic acidosis in adults with DKA especially in developing countries where the incidence and mortality of DKA remain high.
    Endocrine Practice 09/2013; 20(3):1-27. DOI:10.4158/EP13250.OR · 2.59 Impact Factor
  • Contemporary Clinical Trials 09/2013; 36(1):154-165. DOI:10.1016/j.cct.2013.06.015 · 1.99 Impact Factor
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    ABSTRACT: We wish to develop a CT scan-based scoring system which estimates the probability of adnexal mass malignancy. Patients (324) undergoing adnexal mass surgery were recruited into the study from June 1, 2002, to January 1, 2009. All study patients had a preoperative CT scan and serum CA-125 test. CT scan abnormalities included any solid tumor components, ascites, and pelvic or abdominal lymphadenopathy and omental caking. There were 225 (70 %) benign and 99 (30 %) malignant ovarian masses. Using logistic regression with the area under the curve of the receiver operating curve of 82 %, the cancer probability was determined by the equation.[Formula: see text]where A = age, B = CA-125, C = solid adnexal mass is 1 and cystic is 0, D = ascites is 1, E = omental caking is 1 and absence is 0, F = node size ≥1 cm is 1 and <1 cm is 0 value. The natural logarithm e is a constant [2.718281828]. For example, for a woman of age 60, CA-125 = 50 U/mL, with solid adnexal mass, ascites, omental caking, and lymphadenopathy, the probability is 0.994. Hence, this woman has a 99.4 % probability of having cancer. The computed tomography adnexal mass score combines CT scan findings, CA-125, and patient age into an equation to predict the malignant probability of an adnexal mass.
    Archives of Gynecology 08/2013; 289(3). DOI:10.1007/s00404-013-3013-7 · 1.28 Impact Factor
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    ABSTRACT: Objectives- To evaluate whether picture archiving and communication systems (PACS) adequately satisfy radiologists' needs in ultrasound (US) imaging and which PACS functions may be inadequately implemented for handling US diagnosis. Methods- An electronic survey was sent to the membership of the Society of Radiologists in Ultrasound asking them to rate their PACS experience for different modalities, judge the quality of various PACS functions having an impact on US practice and diagnosis, indicate if they felt a need for US-related PACS functions to be implemented or improved, and rate PACS-related improvements for different components of their US practice. Results- Of the 161 respondents, 112 (70%) used a general radiology PACS. Of these respondents, only 53.2% gave a high rating to the US experience in PACS, significantly lower (P < .0001) than for computed tomography (85.2%), magnetic resonance imaging (84.4%), and radiography (83.2%). The functionality of US-specific display, image-processing, and data management PACS processes were graded significantly lower than basic PACS display functions. Only 0.9% of respondents highly rated PACS handling of 3-dimensional US volume data, whereas 92% highly rated the quality of the black-and-white US image display (P < .0001). Most respondents would like most of these US-specific functions implemented or improved, and most respondents stated that PACS has improved their US practice in different ways, although the contribution in more complex image analysis is lagging. Conclusions- Radiologists with a special interest in US believe that the PACS experience for US is lacking. This research helps identify those specific tasks that may further improve work efficiency and diagnostic confidence.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2013; 32(8):1377-84. DOI:10.7863/ultra.32.8.1377 · 1.53 Impact Factor

Publication Stats

2k Citations
402.49 Total Impact Points

Institutions

  • 2005–2015
    • The University of Tennessee Health Science Center
      • • Division of Biostatistics and Epidemiology
      • • Division of Endocrinology, Diabetes and Metabolism
      • • Department of Preventive Medicine
      • • Department of Obstetrics and Gynecology
      Memphis, Tennessee, United States
  • 1998–2014
    • University of Tennessee
      • • Department of Preventive Medicine
      • • Department of Obstetrics and Gynecology
      Knoxville, Tennessee, United States
  • 2013
    • The University of Tennessee Medical Center at Knoxville
      Knoxville, Tennessee, United States
  • 2009
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1998–2006
    • The University of Memphis
      Memphis, Tennessee, United States
  • 2003–2004
    • Louisiana State University in Shreveport
      Shreveport, Louisiana, United States