scholarly journals 534 Use of Ultrasound by Breast Surgeons Reduces the Need for Wire-Guided Localisation Of Impalpable Breast Tumours By Radiologists

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Patel ◽  
S Govindarajulu ◽  
A Sahu
Keyword(s):  
Patient Experience ◽  
Ultrasound Guidance ◽  
Significant Proportion ◽  
Lesion Size ◽  
Breast Tumours ◽  
X Ray ◽  
Image Guided ◽  
Core Part ◽  
Improve Patient ◽  
Operating Surgeon

Abstract Aim Ultrasound is increasingly being used by non-radiologists in clinical practice. Currently wire-guided localisation (WGL) of impalpable breast tumours requires the expertise of radiologists but can be uncomfortable and demands significant radiology resource. Furthermore, for logistical reasons at our institution during the COVID pandemic, wires were inserted the day before surgery, resulting in disruption to patients. At our institution, two of eight breast surgeons use ultrasound intraoperatively for localisation of breast lesions, thus obviating the need for a radiologist to localise the lesion for the surgeon. We hypothesise that ultrasound-localisation by surgeons is an effective way to improve patient experience. Method We undertook a retrospective review of all patients undergoing wire-guided localisation of impalpable breast tumours between 01/05/20-01/08/20. We retrospectively collected the following data: modality of image-guided insertion (ultrasound versus x-ray), operating surgeon and size of tumour. Results 48 tumours were excised using WGL. 45 of these relied on ultrasound guidance for insertion. The median lesion size was 17mm, with 30 (62.5%) of lumps being ³10mm in size. Conclusions Most impalpable lumps were visualised using ultrasound. The majority of these lumps were >10mm. Surgeons trained in ultrasound did not need localisation by radiologists. If breast surgeons were unanimously trained to use ultrasound for intra-operative localisation, a significant proportion of wires could be avoided, saving cost, radiology time, patient time and improving the patient experience. We argue that ultrasound should be a core part of breast trainees’ curriculum.

scholarly journals Ultrasound-Guided IV Placement by Emergency Department Nurses versus Hospital IV Insertion Team- A Retrospective Study of Time to Successful Insertion

2020 ◽  
Author(s):  
Virginia LaBond ◽  
Nicholaus Josey ◽  
Roya Caloia D.O. M.P.H. FACEP ◽  
Jennifer Hella ◽  
Kimberly Barber
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Patient Experience ◽  
Ultrasound Guidance ◽  
Waiting Times ◽  
Ultrasound Guided ◽  
Emergency Department Nurses ◽  
Significant Difference ◽  
Primary Measure ◽  
Improve Patient

Abstract Background IV access in the emergency and acute care settings can often present as a challenge for patient care employees who are tasked with the essential task of placing an IV into a patient’s vein. This study compares time to IV placement by a IV Resource Insertion team compared to trained ER nurses in the skill of ultrasound guided.Methods This was a single site retrospective study which looked at the time to IV placement between a trained team of ER nurses and a formal IV insertion team, both using ultrasound guidance. The primary measure time to IV placement; age, gender, comorbidities and signs of infection were also reported.Results Thirty patients were chosen for each group. There was a statistically significant difference in times to IV placement between the ultrasound guided IV ER nurse team and the formal IV insertion team, with shorter times to IV insertion by the trained ER nurse team.Conclusion This study lends credibility to the notion that Emergency Department personal should be encouraged to learn and utilize US guided IV insertion to better improve patient waiting times for things such as lab results, IV fluids and antibiotics. This will improve patient experience and care. It will also help to decompress resource stressed health systems.

A Modified CGM Algorithm Enhances Data Availability While Retaining iCGM Performance

2021 ◽  
pp. 193229682110075
Author(s):  
Rebecca A. Harvey Towers ◽  
Xiaohe Zhang ◽  
Rasoul Yousefi ◽  
Ghazaleh Esmaili ◽  
Liang Wang ◽  
...  
Keyword(s):  
Data Integration ◽  
Patient Experience ◽  
Real World ◽  
Data Availability ◽  
Post Processing ◽  
Sensor Error ◽  
The Mean ◽  
The Difference ◽  
Data Gap ◽  
Improve Patient

The algorithm for the Dexcom G6 CGM System was enhanced to retain accuracy while reducing the frequency and duration of sensor error. The new algorithm was evaluated by post-processing raw signals collected from G6 pivotal trials (NCT02880267) and by assessing the difference in data availability after a limited, real-world launch. Accuracy was comparable with the new algorithm—the overall %20/20 was 91.7% before and 91.8% after the algorithm modification; MARD was unchanged. The mean data gap due to sensor error nearly halved and total time spent in sensor error decreased by 59%. A limited field launch showed similar results, with a 43% decrease in total time spent in sensor error. Increased data availability may improve patient experience and CGM data integration into insulin delivery systems.

scholarly journals Hydrothermal Synthesis of Iridium-Substituted NaTaO3 Perovskites

Nanomaterials ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1537
Author(s):  
David L. Burnett ◽  
Christopher D. Vincent ◽  
Jasmine A. Clayton ◽  
Reza J. Kashtiban ◽  
Richard I. Walton
Keyword(s):  
Significant Proportion ◽  
Edge Length ◽  
Perovskite Oxide ◽  
Hydrogen Yield ◽  
Orthorhombic Space Group ◽  
X Ray ◽  
Profile Fitting ◽  
Transmission Electron ◽  
Scanning Transmission ◽  
One Step

Iridium-containing NaTaO3 is produced using a one-step hydrothermal crystallisation from Ta2O5 and IrCl3 in an aqueous solution of 10 M NaOH in 40 vol% H2O2 heated at 240 °C. Although a nominal replacement of 50% of Ta by Ir was attempted, the amount of Ir included in the perovskite oxide was only up to 15 mol%. The materials are formed as crystalline powders comprising cube-shaped crystallites around 100 nm in edge length, as seen by scanning transmission electron microscopy. Energy dispersive X-ray mapping shows an even dispersion of Ir through the crystallites. Profile fitting of powder X-ray diffraction (XRD) shows expanded unit cell volumes (orthorhombic space group Pbnm) compared to the parent NaTaO3, while XANES spectroscopy at the Ir LIII-edge reveals that the highest Ir-content materials contain Ir4+. The inclusion of Ir4+ into the perovskite by replacement of Ta5+ implies the presence of charge-balancing defects and upon heat treatment the iridium is extruded from the perovskite at around 600 C in air, with the presence of metallic iridium seen by in situ powder XRD. The highest Ir-content material was loaded with Pt and examined for photocatalytic evolution of H2 from aqueous methanol. Compared to the parent NaTaO3, the Ir-substituted material shows a more than ten-fold enhancement of hydrogen yield with a significant proportion ascribed to visible light absorption.

scholarly journals Categorizing and Rating Patient Complaints: An Innovative Approach to Improve Patient Experience

2021 ◽  
Vol 8 ◽  
pp. 237437352199862
Author(s):  
Stephanie Bayer ◽  
Paul Kuzmickas ◽  
Adrienne Boissy ◽  
Susannah L. Rose ◽  
Mary Beth Mercer
Keyword(s):  
Patient Experience ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Experiences ◽  
Innovative Approach ◽  
Satisfaction Survey ◽  
Patient Complaints ◽  
Academic Medical ◽  
Survey Results ◽  
Improve Patient

The Ombudsman Office at a large academic medical center created a standardized approach to manage and measure unsolicited patient complaints, including methods to identify longitudinal improvements, accounting for volume variances, as well as incident severity to prioritize response needs. Data on patient complaints and grievances are collected and categorized by type of issue, unit location, severity, and individual employee involved. In addition to granular data, results are collated into meaningful monthly leadership reports to identify opportunities for improvement. An overall benchmark for improvement is also applied based on the number of complaints and grievances received for every 1000 patient encounters. Results are utilized in conjunction with satisfaction survey results to drive patient experience strategies. By applying benchmarks to patient grievances, targets can be created based on historical performance. The utilization of grievance and complaint benchmarking helps prioritize resources to improve patient experiences.

X-ray volumetric imaging in image-guided radiotherapy: The new standard in on-treatment imaging

2006 ◽  
Vol 64 (2) ◽  
pp. 625-634 ◽  
Author(s):  
Catherine A. McBain ◽  
Ann M. Henry ◽  
Jonathan Sykes ◽  
Ali Amer ◽  
Tom Marchant ◽  
...  
Keyword(s):  
Image Guided Radiotherapy ◽  
Volumetric Imaging ◽  
X Ray ◽  
Image Guided

Patientoriented Algorithm for the X-ray Therapy Cabinet of Oncology Dispensary

2021 ◽  
Vol 66 (5) ◽  
pp. 45-49
Author(s):  
J Zuenkova ◽  
D. Kicha ◽  
A. Abramov ◽  
Y. Buynova ◽  
L. Klisova
Keyword(s):  
Patient Satisfaction ◽  
Skin Cancer ◽  
Patient Experience ◽  
Adherence To Treatment ◽  
Patient Centered ◽  
X Ray ◽  
Non Melanoma Skin Cancer ◽  
Study Results ◽  
Therapy Room ◽  
Melanoma Skin

Results: IIntroduction: Superficial X-ray therapy is a common treatment of non-melanoma skin cancer with a high incidence worldwide. Interrupting the course of radiation therapy can negatively affect patient survival and treatment results. Low treatment adherence may be associated with a lack of a patient-centered approach and ineffective communications. The original study shows that patients undergoing X-ray therapy for cancer may have different needs. Based on the study results an algorithm for a patient-oriented approach has been developed for the X-ray cabinets. Purpose: To develop a patient-oriented algorithm of the X-ray therapy room to address the issues of increasing patient satisfaction and forming their adherence to treatment. The objectives of the study included studying and detailing the needs of the patients who passed the X-ray therapy and to develop the patient-oriented algorithm for the X-ray therapy room. Material and methods: The study of the patient's values was carried out from 2019 to 2020 by interviewing using open-ended questions to find out the deep motives and beliefs of patients. The study was based on Milton Rokich’s (2005) model of value orientations, which was adapted to the objectives of the study. Results: The study included 116 patients undergoing treatment with the X-ray therapy at the City Clinical Oncology Dispensary. As a result of the study, the following patient needs were identified: clinical outcome of the procedure 111 (96 %), safety of treatment and adverse reactions 106 (91 %), cosmetic outcome 53 (46 %), convenience of the treatment schedule 42 (36 %), painlessness of the procedure 39 (34 %), the ability to lead a normal lifestyle 27 (23 %), comfortable conditions for the procedure 16 (14 %), financial costs associated with treatment 10 (9 %), preservation of organ function 4 (3 %). On the basis of the data obtained, a patient-oriented algorithm for the X-ray therapy was developed, including a communication plan with the patient. The study results clearly demonstrate that even with the same disease and condition, patients may have different priorities hat need to be considered to improve patient experience and adherence to treatment. Conclusion: Radiation treatment decision-making based on the patients values is important for the development of the patient-centered management in oncology since this directly affects patients’ adherence to treatment. Exploring the values and needs of patients is an opportunity to influence and improve the metrics of the patient experience. Due to the mass incidence of non-melanoma skin cancer, the introduction of patient-centered approaches is an important part of patient satisfaction and increase of patients adherence to the treatment.

Broadening the concept of patient safety culture through value-based healthcare

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Viktor Dombrádi ◽  
Klára Bíró ◽  
Guenther Jonitz ◽  
Muir Gray ◽  
Anant Jani
Keyword(s):  
Patient Safety ◽  
Patient Experience ◽  
Safety Culture ◽  
Improve Patient Safety ◽  
Cost Benefit ◽  
Population Level ◽  
Patient Safety Culture ◽  
Content Type ◽  
Experience Of Care ◽  
Improve Patient

PurposeDecision-makers are looking for innovative approaches to improve patient experience and outcomes with the finite resources available in healthcare. The concept of value-based healthcare has been proposed as one such approach. Since unsafe care hinders patient experience and contributes to waste, the purpose of this paper is to investigate how the value-based approach can help broaden the existing concept of patient safety culture and thus, improve patient safety and healthcare value.Design/methodology/approachIn the arguments, the authors use the triple value model which consists of personal, technical and allocative value. These three aspects together promote healthcare in which the experience of care is improved through the involvement of patients, while also considering the optimal utilisation and allocation of finite healthcare resources.FindingsWhile the idea that patient involvement should be integrated into patient safety culture has already been suggested, there is a lack of emphasis that economic considerations can play an important role as well. Patient safety should be perceived as an investment, thus, relevant questions need to be addressed such as how much resources should be invested into patient safety, how the finite resources should be allocated to maximise health benefits at a population level and how resources should be utilised to get the best cost-benefit ratio.Originality/valueThus far, both the importance of patient safety culture and value-based healthcare have been advocated; this paper emphasizes the need to consider these two approaches together.

scholarly journals Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

Breast Care ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. 364-368 ◽  
Author(s):  
Doris Leithner ◽  
Benjamin Kaltenbach ◽  
Petra Hödl ◽  
Volker Möbus ◽  
Volker Brandenbusch ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Statistical Tests ◽  
Menopausal Status ◽  
Surgical Excision ◽  
Lesion Size ◽  
Intraductal Papilloma ◽  
Image Guided ◽  
Institutional Review

Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.

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