Advocate Lutheran General Hospital (ALGH) is a 645-bed non-profit teaching hospital located in the Chicago suburb of Park Ridge, Illinois. Founded in 1897, Advocate Lutheran General Hospital is the sixth largest hospital in the Chicago area, and it operates a Level I trauma center. It also is home to Advocate Children's Hospital – Park Ridge, the only children's hospital in the greater north and northwest suburban region of Chicago. The hospital is a part of Advocate Aurora Health.In the last year with available data, Advocate Lutheran General Hospital had 29,025 admissions, 62,544 emergency department visits, and its surgeons performed 6,728 inpatient and 12,431 outpatient surgeries. The hospital is gold certified by the Leadership in Energy and Environmental Design (LEED). The inpatient rehabilitation program accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). The echocardiogram lab is accredited by the Intersocietal Accreditation Commission.ALGH operates a number of residency programs, which train newly graduated physicians in various specialties and sub-specialties. The hospital is associated with the Chicago Medical School at Rosalind Franklin University of Medicine and Science and Chicago College of Osteopathic Medicine at Midwestern University.
BACKGROUND:Detection of large vessel occlusions using a deep learning (DL) algorithm for the anterior circulation has shown promising results. However, the role of DL algorithms in detecting posterior circulation large vessel occlusion (PC-LVO) remains uncertain. We aimed to evaluate the diagnostic performance of a DL algorithm (Methinks PC-LVO) for detecting PC-LVO using noncontrast computed tomography. METHODS:This is a retrospective, multicenter, observational cohort study that included patients with PC-LVO who underwent both noncontrast computed tomography and computed tomography angiography. The diagnostic performance of the DL algorithm was assessed by analyzing sensitivity, specificity, and area under the curve for PC-LVO detection of consecutive PC-LVO strokes. For comparative analysis, the area under the curve of the DL algorithm was also evaluated against the performance of a neuroradiologist interpreting noncontrast computed tomography. Ground truth labels were established through consensus readings by expert neuroradiologists. Subgroup analyses were performed according to clot location (proximal posterior cerebral artery and basilar artery) and National Institutes of Health Stroke Scale (NIHSS) score (NIHSS score ≥6, NIHSS score ≥8, and NIHSS score ≥10). RESULTS:A total of 196 patients were included, of whom 74 patients had PC-LVO. Among these, 43 had basilar artery occlusions, and 34 had proximal posterior cerebral artery occlusions. The overall sensitivity and specificity of the software were 55.4% and 80.9%, respectively, with an area under the curve of 0.72. The neuroradiologist achieved a sensitivity of 27.4% and specificity of 91.8%. Among patients with proximal posterior cerebral artery occlusion, sensitivity was 55.9%, whereas for basilar artery occlusion, it was 53.5%. When stratified by NIHSS score ≥10, sensitivity in the proximal posterior cerebral artery was 56.2%, and for the basilar artery with NIHSS score ≥10, it increased to 61.5%. CONCLUSIONS:Our initial experience with a DL algorithm for the detection of PC-LVO showed promising results. However, further improvements are required before the algorithm can be implemented in clinical practice.
Background/Objectives: Laparoscopic cholecystectomy (LC) is the current gold standard in patients with acute cholecystitis. Percutaneous cholecystostomy (PC) remains an option for those who are not surgical candidates but is associated with adverse effects. We studied technical success and patient satisfaction for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) after initially receiving a PC drain. Methods: A multi-center study was conducted at 4 institutions involving patients who initially received a PC. These patients were given the option to transition to receive EUS-GBD. A 5-point Likert scale was used to assess patient satisfaction comparing PC vs. EUS-GBD. Demographic data, including age, sex, reason for PC, complications, and patient satisfaction scores, were collected. Result: All seven patients who underwent percutaneous cholecystostomy rated their experience as 1 (very dissatisfied), whereas the same patients rated EUS-guided gallbladder drainage with a mean satisfaction score of 4.7 (very satisfied). Conclusions: EUS-GBD is effective and offers higher satisfaction scores in patients who are not surgical candidates.
