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PubMed2005

[Patient safety in diagnostic ultrasound II--ultrasound guided interventions].

New digital ultrasound techniques simplify the documentation of ultrasound images and allow better comparison with respect to different image modalities. New vascular imaging modes including contrast enhanced power Doppler and 3D power Doppler allow for the detection of very small vessels and leakages. B-flow, a recently introduced digital substraction technique is advancing the detection of residual blood flow in high-grade stenosis without vibration artifacts. Modern contrast agents allow to perform ultrasound guided intervetion such as biopsies and ablation therapies with improved accuracy. This way, the risk for complications can be significantly reduced.

Aortic Aneurysm, Abdominal↗
PubMed2006

Protocols for dosimetry and patient reference levels.

Doses in radiology should be as low as reasonably achievable. In order to compare practice in different centres it is necessary to compare patient doses. This can only be undertaken if dosimetry studies are similar. In order to facilitate comparisons, the DIMOND consortium developed a patient dosimetry protocol. Reference doses have been proposed to identify centres where optimisation studies would be of benefit. Whilst reference doses have been established for common radiographic and fluoroscopic examinations, little research has been undertaken in the area of digital radiology, partly owing to the rapid technological changes occurring in digital and interventional radiology. Dosimetry data obtained by the DIMOND research project were compared with data from published literature. Data for various digital and interventional radiology procedures were reviewed. Proposals are made for reference doses. There is obviously a need for standardised approaches to patient dosimetry, which should be recorded in the hospital's information system.

Angioplasty↗
PubMed1993

Buffered versus plain lidocaine for digital nerve blocks.

STUDY OBJECTIVES: To test whether buffered lidocaine is less painful to administer as a digital nerve block than plain lidocaine. DESIGN: Randomized, double-blind, prospective clinical trial. SETTING: University hospital emergency department. PARTICIPANTS: Adults not allergic to lidocaine requiring a digital nerve block. INTERVENTIONS: Subjects received digital nerve blocks by injection of buffered lidocaine on one side and plain lidocaine on the other in a predetermined, randomized order. Pain of infiltration was assessed. Scores were compared using a two-tailed t-test. Standard 1% lidocaine was used if additional anesthetic was required. MEASUREMENTS AND MAIN RESULTS: Thirty-one patients were enrolled. Buffered lidocaine was significantly less painful to administer than plain lidocaine (P < .001; t = 4.21). Supplemental anesthesia was required less often for buffered lidocaine (two times) compared with plain lidocaine (six times), although this difference was not statistically significant. CONCLUSION: Because it causes less pain and is equally efficacious, buffered lidocaine is preferable to plain lidocaine for digital nerve blocks in adults.

Adolescent↗
PubMed1997

Patient dose in radiologically guided interventional vascular procedures: conventional versus digital systems.

PURPOSE: To calculate the difference in the patient radiation dose in radiologically guided interventional vascular procedures between conventional and digital systems and to estimate the effective dose and the energy imparted with the digital system. MATERIALS AND METHODS: A total of 318 procedures (in 318 patients) in 15 different examination groups were analyzed. The dose-area product was determined by using a transmission chamber fitted to an x-ray-tube light-beam diaphragm; the effective dose was determined by using software. RESULTS: Urinary and biliary tract procedures showed small differences in the average dose-area product between conventional and digital systems. The dose-area products in the vascular procedures were higher with the digital than with the conventional system. The average effective dose and energy imparted were 0.88 mSv and 129 mJ, respectively, in the subcutaneous placement of a reservoir for analgesic administration and as much as 25.7 mSv and 829 mJ, respectively, in spermatic vein embolization. CONCLUSION: The dose-area product was higher with the digital system than with the conventional system in 13 of the 15 groups. To reduce the patient dose in vascular interventional radiology procedures, the training of personnel and the frequent use of conventional fluoroscopy and low-dose imaging are required.

Adult↗
PubMed2026

Facilitating Thought Progression via a Gamified Mobile Application for Depression: Possible Mediators of Outcomes.

Mobile health interventions represent a scalable and accessible alternative to traditional therapy, which often is out of reach due to high costs and societal stigma. Rumination is considered a key mechanism of emotional disorders and represents a potential treatment target for digital health interventions. The current study investigated the role of rumination as a mediator of the reduction in depression and anxiety reported after the use of a gamified mobile app based on the Facilitating Thought Progression (FTP) framework. One hundred-one adults with mild to moderate depression were randomized to the FTP intervention or a waitlist control group and completed weekly assessments of depression, anxiety, and rumination over 8 weeks. Multilevel structural equation modeling revealed that reduction in rumination significantly mediated decreases in depression and anxiety in the intervention group but not in the waitlist condition. These findings suggest that the FTP app targeted rumination and further highlights its role as a critical target for interventions for depression and anxiety.

Adult↗
PubMed2004

Patient adherence to skin self-examination. effect of nurse intervention with photographs.

BACKGROUND: Results from a single case-control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. The purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. DESIGN SETTING/PARTICIPANTS: Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) were recruited from the outpatient Pigmented Lesion Clinic at Memorial Sloan-Kettering Cancer Center. All participants had baseline whole-body digital photography as part of their clinical evaluation. INTERVENTION: Patients were randomized: Group A (n =49) received a teaching intervention (physician and nurse education module) with a photo book (personal whole-body photographs compiled in the form of a booklet, with nurse instruction on how to use the photographs); and Group B (n =51) received the teaching intervention only without a photo book. MAIN OUTCOMES/MEASURES: Self-administered questionnaires were provided at three intervals: baseline, post-teaching intervention, and at the 4-month post-baseline visit. To assess adherence with SSE, patients were asked, "How many times in the past 4 months did you (or someone else) usually, thoroughly examine your skin?" RESULTS: In Group A (teaching intervention with photo book), 10.2% of the patients at baseline reported skin examination three or more times during the past 4 months, while 61.2% reported skin examination three or more times at the 4-month follow-up (p =0.039 for paired comparison). In Group B (teaching intervention only), nearly 20% of the patients at baseline reported skin examination three or more times during the past 4 months, while 37% reported skin examination three or more times at the 4-month follow-up (p =0.63). The increase in reported skin examination was compared between the two groups (>51% v >17.6%, p =0.001). CONCLUSIONS: The results suggest that a brief nurse-delivered intervention is effective at increasing patient adherence with SSE. Utilizing digital photographs as an adjunct to screening appeared to increase patient adherence to performing SSE.

Adolescent↗
PubMedDate not supplied

Implementing personal digital assistant documentation of pharmacist interventions in a military treatment facility.

OBJECTIVE: To describe the use of personal digital assistants (PDAs) in documenting pharmacists' clinical interventions. SETTING: Evans Army Community Hospital (EACH), a 78-bed military treatment facility, in Colorado Springs. PARTICIPANTS: Pharmacists on staff at EACH. PRACTICE DESCRIPTION: All pharmacists at EACH used PDAs with the pilot software to record interventions for 1 month. The program underwent final design changes and then became the sole source for recording pharmacist interventions. The results of this project are being evaluated every 3 months for the first year and yearly thereafter. PRACTICE INNOVATION: Visual CE (Syware Inc. Cambridge, Mass.) software was selected to develop fields for the documentation tool. This software is simple and easy to use, and users can retrieve reports of interventions from both inpatient and outpatient sections. The software needed to be designed so that data entry would only take a few minutes and ad hoc reports could be produced easily. MAIN OUTCOME MEASURES: Number of pharmacist interventions reported, time spent in clinical interventions, and outcome of clinical intervention. RESULTS: Implementing a PDA-based system for documenting pharmacist interventions across ambulatory, inpatient, and clinical services dramatically increased reporting during the first 6 months after implementation (August 2004-February 2005). After initial fielding, clinical pharmacists in advanced practice settings (such as disease management clinic, anticoagulation clinic) recognized a need to tailor the program to their specific activities, which resulted in a spin-off program unique to their practice roles. CONCLUSION: A PDA-based system for documenting clinical interventions at a military treatment facility increased reporting of interventions across all pharmacy points of service. Pharmacy leadership used these data to document the impact of pharmacist interventions on safety and quality of pharmaceutical care provided.

Computers, Handheld↗
PubMed1989

[Digital subtraction dacryocystography following surgical interventions].

In our series of over 60 dacryocystograms using the digital subtraction technique we report on two cases in which this examination was done postoperatively. The fine, detailed presentation of the topography showed that the dacryorhinostomy was functionally open in spite of the suspicion of clinical failure. In the second case, the fine fistulas between the nasolacrimal duct and maxillary sinus could only be demonstrated by the subtraction study. A conventional dacryocystogram failed to show this important detail. The time necessary for both examination techniques is about equal. Digital subtraction dacryocystography has the advantages of immediate availability, the capacity to observe the flow of the contrast medium kinetically and a superior topography display. It is therefore ideal for the evaluation of postoperative topography after lacrimal and sinus surgery.

Aged↗
PubMed2000

Organ doses, detriment and genetic risk from interventional vascular procedures in Málaga (Spain).

Nowadays, the radiological risk from simple X-ray procedures is well known. The purpose of this work has been to estimate the population risk from digital angiographic and interventional procedures and to compare it with the one from simple procedures in the same population. The population risk has been estimated according to the following quantities: genetically significant dose, somatic significant dose, collective effective dose, annual per caput effective dose and detriment. These have been estimated from dose area product and organ dose. Organ dose values were estimated with the Eff-Dose software. A population of 605410 people were included in the study. In 1996, 1312 patients were to digital interventional vascular procedures in Malaga, and 159 of them were selected in this research project to obtain the dose area product and organ dose. The results obtained for the quantities evaluated are: genetically significant dose, 4.1 microGy; somatic significant dose, 0.9 mSv; collective effective dose, 11.65 person-Sv: annual per caput effective dose, 0.02 mSv and detriment, 0.65 radiogenic cancers per year. These procedures supply a high radiation dose, so they should have a greater contribution to population dose and risk than simple examinations. However, our results indicate just the opposite.

Adolescent↗
PubMed2006

Comparison of a CCD and a flat-panel digital system in an Interventional Cardiology Laboratory.

We evaluated the performances of angiographic units equipped with a flat-panel (FP) detector and image intensifier (II) charge-coupled device (CCD) in the Interventional Cardiology (IC) Department. Entrance dose rate and dose per image, along with the dose at the II level were measured using 2 mm copper sheets to simulate a patient. Image quality (IQ) was evaluated using a phantom. Doses increased with fluoroscopy level changing from low to high. FP presented higher doses than CCD. Periodic measurements showed differences of up to 35%. Low mode IQ did not significantly differ from normal and high mode for both systems. Low fluoroscopy mode was decided to be used routinely. Both X-ray systems performed within international recommendations for conventional systems with the exception of higher cine radiation doses and II dose rates, stressing the fact that more studies are required to investigate whether dose levels should be adjusted.

Angiography↗
PubMed2001

Value of digital exploration for diagnosing injuries to the left side of the diaphragm caused by stab wounds.

HYPOTHESIS: The digital exploration of stab wounds in the left thoracoabdominal region allows the early diagnosis of diaphragmatic lesions. DESIGN: Diagnostic test study. The digital exploration of the diaphragm was compared with laparotomy (the gold standard) and thoracoscopy. SETTING: The study setting was the Hospital Universitario San Vicente de Paúl (Medellín, Colombia). This is a referral trauma center for the general community. PATIENTS: The study included 82 consecutive patients who were admitted to our institution during a 12-month period with injuries caused by stab wounds to the left thoracoabdominal region and who did not have indications for immediate surgery. Digital exploration of the wound was performed by the attending surgeon in the emergency department. If a lesion of the diaphragm was identified, a laparotomy was performed; if no diaphragmatic lesion was found, a diagnostic left thoracoscopy and/or laparotomy was performed. Results of the laparotomy (n = 63) or thoracoscopy (n = 19) were used as the standard of reference for the determination of sensitivity, specificity, and predictive values of digital exploration. INTERVENTION: The integrity of the diaphragm was determined by digital exploration through the stab wound. MAIN OUTCOME MEASURES: Sensitivity, specificity, predictive value, and likelihood ratio were calculated. RESULTS: For the detection of diaphragmatic lesions, digital exploration demonstrated a sensitivity of 96%, a specificity of 83.3%, a positive predictive value of 91%, and a negative predictive value of 93.7%. CONCLUSION: Digital exploration is a reliable method for the detection of injuries to the left side of the diaphragm caused by stab wounds.

Adolescent↗
PubMedDate not supplied

Standard-protocol moving-table magnetic resonance angiography for planning of interventional procedures in patients with peripheral vascular occlusive disease.

PURPOSE: This study aimed to evaluate the usefulness of magnetic resonance angiography (MRA) for the planning of interventional procedures in the lower extremity vascular territory. MATERIALS AND METHODS: Patients with peripheral vascular occlusive disease (PVOD) underwent MRA for planning of percutaneous interventional treatment. Digital subtraction angiography was performed in patients scheduled for interventional treatment and served as the standard of reference. RESULTS: In 148 out of 150 cases (98.7%), the necessity for an intervention was recognized correctly; 137 out of 150 interventions (91.3%) were correctly planned based on MRA results. CONCLUSION: Contrast-enhanced MRA of the lower extremities is a safe, noninvasive tool for preinterventional assessment of patients with PVOD. It allows exact planning of endovascular interventions.

Adult↗
PubMed2006

The DIMOND project and its impact on radiation protection.

The DIMOND III project comprised work packages and subprojects to research digital imaging, interventional radiology and interventional cardiology, i.e. areas where there has been rapid technological change, not matched by radiation protection research. Whilst new practices have great potential benefit, there are risks to patients and staff if the technology is implemented inappropriately. DIMOND aimed to develop generic technology assessment and optimisation tools. Clinical quality criteria and technical parameters were included so that digital imaging procedures can be introduced appropriately. Frequency and dimensions of acceptance and constancy testing for digital imaging systems were studied, along with differences between objective measures of image quality and subjective indices. Patient dosimetry was performed to propose and to establish reference values. Clinical evaluation projects included cardiology, interventional radiology and digital mammography. As a result of the DIMOND project, quality criteria for several procedures were developed. Example results are presented in this paper.

Cardiology↗
PubMed2002

An evaluation model for psychoeducational interventions using interactive multimedia.

A review of published evaluations of psychoeducational interventions using interactive digital multimedia shows that evaluations typically address only some of the areas that collectively would constitute a comprehensive evaluation. There appears to be a need for an accepted standard for these evaluations, based on a general evaluation model that encompasses all relevant aspects of development, efficacy and use of multimedia interventions. A comprehensive model is proposed which includes special features of multimedia interventions that lead to unique evaluation requirements. The model integrates relevant aspects of program evaluation and clinical trials models in order to provide a unique model that includes all the evaluation domains relevant to digital multimedia interventions. These include evaluation of intervention theory, intervention design strategies, the formative process, intervention efficacy (process and outcome) and contextual issues such as evaluability assessment, reporting and stakeholder issues. The application of individual components of the model is illustrated with reference to problems in the evaluation literature on a particular type of digital multimedia intervention, electroencephalographic biofeedback for Attention-Deficit/Hyperactivity Disorder. The model should be useful for researchers planning evaluations of digital multimedia interventions, especially in the psychoeducational domain. This paper provides a theoretical and evidential background for the evaluation model, and includes a checklist and flowchart for the planning and conduct of the evaluation.

Attention Deficit Disorder with Hyperactivity↗