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PubMedDate not supplied

2003 William J. Stickel Silver Award. Skin temperatures as a one-time screening tool do not predict future diabetic foot complications.

This prospective longitudinal study assessed whether baseline mean skin temperature measurements are useful in predicting the most common foot-related complications of diabetes mellitus. We evaluated the mean of baseline skin temperatures taken bilaterally from six plantar sites in 1,588 patients with diabetes. There was no difference in skin temperature based on neuropathy, foot laterality, or foot risk category or between people with and without foot deformity and elevated plantar foot pressure. Whereas people with Charcot's arthropathy had slightly but significantly higher mean temperatures (84.8 degrees +/- 3.5 degrees F versus 82.5 degrees +/- 4.7 degrees F), this was not true for those who developed ulcers or infections or who underwent amputations. The presence of vascular disease was not associated with lower skin temperatures. Mexican Americans (83.0 degrees +/- 4.6 degrees F) and blacks (83.6 degrees +/- 4.5 degrees F) had higher mean skin temperatures at baseline than did non-Hispanic whites (81.8 degrees +/- 4.6 degrees F). Baseline measurement of nonfocal mean skin temperatures is not an effective means of screening people for future events. Regular assessment of skin temperatures, using the contralateral site as a physiologic control, may be a better use of this technology.

Aged↗
PubMed2004

POC tests cut screening time down to 20 minutes.

Point-of-care testing can significantly reduce your door-to-diagnosis times. Choose device(s) that mirror your most common diagnoses. Training techs as well as RNs helps meet needs of the patient. Be prepared to justify cost by demonstrating improved turnaround.

Efficiency, Organizational↗
PubMed1994

Enteroclysis--the influence of tube design.

The performance of three 10F enteroclysis tubes with different tip designs (E. Merck Ltd) was assessed using double-contrast, gravity infusion enteroclysis, with methylcellulose solution as negative contrast. Intubation times, screening times, patient tolerability and examination quality were compared. The results show that a streamlined tip design facilitated passage through the nose. None of the tubes provided consistently reliable results due to inadequate flow rates. The Corsafe tube transmits a higher flow rate of methylcellulose and produced satisfactory examinations more frequently. Mechanically assisted infusion of methylcellulose is recommended when using 10F enteroclysis tubes.

Enema↗
PubMed2003

Cardiac anatomy screening: what is the best time for screening in pregnancy?

PURPOSE OF REVIEW: To consider the ideal gestational age for cardiac evaluation during pregnancy. RECENT FINDINGS: Screening the heart during routine obstetric ultrasound has become well established and is increasingly successful in the initial detection of major congenital heart disease. When the option of termination of pregnancy is available, the earlier the diagnosis of any major fetal malformation is made, the better for the patient. An important group who have recently been found to be at increased risk of fetal heart malformation are those with increased nuchal translucency measurements, who are identified between 11 and 14 weeks. Thus, screening for fetal anomalies is being attempted much earlier in pregnancy, aided by advances in technology. However, some forms of cardiac malformations do not become evident until the third trimester of pregnancy; as a result, some of the late-developing lesions may go undetected during very early evaluation. SUMMARY: The ideal timing for screening is a compromise between obtaining adequate images for diagnosis in the majority of routine patients, scanning sufficiently late not to miss late-developing lesions and yet offering diagnosis as early as possible for parents to consider their options, if there are any applicable to their particular diagnosis. For low-risk patients, the best compromise appears to be at around 20 weeks of gestation. For patients at increased risk of congenital heart disease, such as those found to have substantially increased nuchal translucency or those with a family history of the disease, an initial scan to exclude major malformations should be performed by the fetal cardiology expert at 12-14 weeks, with follow-up at around 20 weeks to exclude more minor defects and those lesions which may become evident later.

Echocardiography↗
PubMed1989

The influence of type of tube and experience of the operator on performance of small bowel enema.

Seventy patients underwent small bowel enema (SBE) to assess the influence of experience of the radiologist on the ease of jejunal intubation and the adequacy of SBE using two types of tubes. Comparing intubation time, intubation screening time, total screening time and total room time, we conclude that jejunal intubation is achieved easily, in a reasonable time with both types of tube, by all grades of radiologist, although the experienced operator using the Silk tube achieved intubation in a significantly shorter time. Overall patient acceptability was satisfactory (75%) but was better using the Silk tube, with which entero-gastric reflux and vomiting were less.

Adolescent↗
PubMed2005

Defining the learning curve for percutaneous nephrolithotomy.

PURPOSE: To define the learning curve for percutaneous nephrolithotomy (PCNL) using three potential surrogate markers of surgical expertise. MATERIALS AND METHODS: The learning curve of an endourologist with no previous experience at performing solo PCNL was studied. Three putative parameters of expertise were reviewed, namely, operating time, fluoroscopic screening time, and radiation dose. Operations were analyzed in cohorts of 15 to determine when a plateau was reached for all three variables. Comparison was then made with the results of a surgeon who had performed more than 1600 PCNLs. Stone type and stone clearance rate were also noted. RESULTS: The mean operating time of the novice surgeon fell to a plateau of 92 minutes after 60 cases, but screening time and radiation dose did not plateau until case 115, when values of 231 seconds and 406 cGy/cm2 were recorded, respectively. The senior surgeon had a mean operating time of 98 minutes and screening parameters equivalent to those of the novice surgeon after 115 cases. The complexity of the stones tackled grew with increasing experience, although stone-free rates remained constant. CONCLUSIONS: This study of the learning curve of a single surgeon suggests that competence at performing PCNL is reached after 60 cases and excellence after 115. Radiation parameters are a valuable tool in the assessment of operative competence.

Clinical Competence↗
PubMed2006

Ultrasound-guided venous access for permanent pacemaker leads.

BACKGROUND: Existing methods of venous access for permanent pacemaker leads have disadvantages. We documented learning times for ultrasound-guided lead implantation and compared them with cephalic venotomy technique. METHODS: Two implanters learnt ultrasound-guided technique by implanting consecutive pacemaker patients. When procedural times stabilized, we reverted to our normal cephalic approach. We measured lead placement time and screening time from skin incision until all leads were placed in superior vena cava were measured. RESULTS: Initial strategy adopted was ultrasound for 60, then cephalic for 38 patients. There were no significant differences between groups in baseline characteristics or number of leads implanted. Lead placement and screening times were significantly shorter for ultrasound, despite inclusion of all learning cases. There was a high success rate for both strategies (88% ultrasound, 87% cephalic). There was significantly greater use of pressure dressings with ultrasound, but no difference in pocket hematoma or pneumothorax. There was a trend for more predictable lead implant times with ultrasound and fluoroscopy times were shorter and more predictable. Independent predictors of lead placement time were body mass index, operator, initial strategy (ultrasound vs cephalic), and procedure number. CONCLUSION: Ultrasound-guided venepuncture for placement of permanent pacing leads is quick to learn and achieves faster lead placement times with shorter and more predictable fluoroscopy time when compared with the cephalic venotomy technique.

Adult↗
PubMedDate not supplied

Retrograde vs. antegrade puncture for infra-inguinal angioplasty.

This study was done to compare antegrade punctures with a retrograde puncture technique for infrainguinal angioplasty. A group of 100 consecutive patients (71 men, 29 women) were randomized for antegrade puncture or retrograde puncture of the common femoral artery. Following retrograde puncture the guidewire was 'turned' and placed into the superficial femoral artery. The time for gaining access, screening time, radiation dose, patient height, weight and complications were recorded. All patients were reviewed the day after the procedure and within 3 months. Data from 46 patients (34 males and 12 females) in the retrograde group and 44 (28 males and 16 females) in the antegrade group were available for analysis. Mean procedure time, screening time, radiation dose, height and weight were 8.3 minutes (range 3-22), 2.1 minutes (0.3-6.5), 7950 mGy cm(-2) (820-71250), 169 cm (149-204) and 79 kg (32-108) for retrograde puncture and 8 min (2-60), 0.7 min (0.0-3.2), 1069 mGy cm(-2) (0-15400), 169 cm (152-186) and 75 kg (39-125) for antegrade punctures, respectively. An average of 1.2 (1-2) punctures was required for retrograde and 1.75 (1-8) for antegrade. Seven small hematomas occurred with antegrade and three for retrograde puncture. Retrograde puncture is technically easier with a tendency to fewer complications but results in a higher radiation dose. This technique should be used in difficult patients at high risk of haematoma formation.

Aged↗
PubMed2007

The treatment of transtrochanteric fractures of the femur with a minimally invasive technique using an extramedullary implant MINUS System.

We report here the results of a retrospective study on 120 patients treated for transtrochanteric fractures of the femur using a minimally invasive technique with an extramedullary sliding pin as implant - which we denoted the MINUS System. The evaluation was carried out in in the postoperative period, and the levels of haemoglobin (Hb) and haematocrit (Ht), surgical time, radiological screening time and pain levels were recorded. Prior to the operation, mean Hb and Ht were 11.69 g/dl and 35.72%, respectively; in the immediate postoperative period, they were 10.35 g/dl and 32.4%, respectively. Mean operating time was 39.35 min. Average postoperative pain was assessed at 4.44 (on a scale of 1 to 10). The average time for screening was 1.07 min. Based on these criteria, we conclude that the minimally invasive technique of the MINUS System allows for a shorter operating time and a minimal blood loss in the treatment of transtrochanteric fractures of the femur.

Aged, 80 and over↗
PubMed1993

Use of a remotely controlled mechanical pump for coronary arteriography: a study of radiation exposure and quality implications.

BACKGROUND: Exposure to radiation is a hazard of invasive cardiology. To minimise the risk it is essential to keep the doses received as low as possible. AIM: To assess the effect on cardiologist radiation exposure and the quality of coronary artery opacification of the use of a remotely controlled mechanical pump for coronary arteriography. A secondary aim was to assess any disadvantages and safety. METHODS: 319 patients were randomised to have coronary arteriography carried out with contrast injected either by hand or by a remotely controlled mechanical pump. Six cardiologists participated: two catheter laboratories were used and both brachial and femoral approaches were included. The exposure of the cardiologists to radiation was assessed by film badge dosimetry. The badges were worn on the hat. The total time for the procedure, screening time, the dose-area product meter reading, and any complications were recorded for each examination. The quality of arterial opacification was reported on a scale of 0-5. RESULTS: The mean radiation dose per procedure was 0.011 mSv for hand injection of contrast and 0.005 mSv for mechanical injection (p < 0.01). There were no differences in procedure times or screening times. There were no complications attributable to mechanical injection. Arterial opacification was not significantly different in the two groups (4.01 v 4.03 for the left coronary artery, 4.68 v 4.78 for the right coronary artery). The right coronary artery was consistently better opacified than the left by both techniques (4.59 v 3.89, p < 0.001). CONCLUSIONS: Use of a remotely controlled mechanical pump for coronary arteriography reduced cardiologist radiation exposure by half. It was not associated with any inconvenience, expense, or complications and produced arterial opacification at least as good as injection by hand.

Cardiology↗
PubMed2007

Radiation doses to children during modified barium swallow studies.

BACKGROUND: There are minimal data on radiation doses to infants and children undergoing a modified barium swallow (MBS) study. OBJECTIVE: To document screening times, dose area product (DAP) and effective doses to children undergoing MBS and to determine factors associated with increased screening times and effective dose. MATERIALS AND METHODS: Fluoroscopic data (screening time, DAP, kVp) for 90 consecutive MBS studies using pulse fluoroscopy were prospectively recorded; effective dose was calculated and data were analyzed for effects of behavior, number of swallow presentations, swallowing dysfunction and medical problems. RESULTS: Mean effective dose for the entire group was 0.0826 +/- 0.0544 mSv, screening time 2.48 +/- 0.81 min, and DAP 28.79 +/- 41.72 cGy cm2. Significant differences were found across three age groups ( 1.0-3.0 and >3.0 years) for effective dose (mean 0.1188, 0.0651 and 0.0529 mSv, respectively; P < 0.001), but not for screening time or DAP. Effective dose was correlated with screening time (P = 0.007), DAP (P < 0.001), number of swallow presentations (P = 0.007), lower age (P = 0.017), female gender (P = 0.004), and height (P < 0.001). Screening time was correlated with total number of swallow presentations (P < 0.001) and DAP (P < 0.001). CONCLUSION: Screening times, DAP, effective dose, and child and procedural factors associated with higher effective doses are presented for children undergoing MBS studies.

Administration, Oral↗
PubMed2000

Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages.

OBJECTIVE: One-time colonoscopy has been recommended as a possible colorectal cancer (CRC) screening strategy. Because the incidence of colorectal neoplasia increases with age, the effectiveness and cost of this strategy depend on the age at which screening occurs. The purpose of this study was to investigate the age-dependent cost-utility of one-time colonoscopic screening. METHODS: We constructed a computer simulation model of the natural history of colorectal neoplasia. This model was used to compare the cost-utility of no screening and age-based strategies employing one-time colonoscopic screening (age ranges evaluated: 45-49, 50-54, 55-59, and 60-64 yr). RESULTS: We determined that one-time colonoscopic screening in men age <60 yr and in women age <65 yr dominates never screening and screening at older ages. For both sexes, one-time colonoscopic screening between 50 and 54 yr of age is associated with a marginal cost-utility of less than $10,000 per additional quality-adjusted life-year compared to screening between 55 and 60 yr of age. One-time colonoscopic screening between 45 and 49 yr of age is either dominated (women) or associated with a marginal cost-utility of $69,000/per quality-adjusted life-year (men) compared to screening between 50 and 54 yr of age. The marginal cost-utility of one-time colonoscopic screening is relatively insensitive to plausible changes in the cost of colonoscopy, the cost of CRC treatment, the sensitivity of colonoscopy for colorectal neoplasia, the utility values representing the morbidity associated with the CRC-related health states, and the discount rate. CONCLUSIONS: One-time colonoscopic screening between 50 and 54 yr of age is cost-effective compared to no screening and screening at older ages in both men and women. Screening in men between 45 and 49 yr of age may be cost-effective compared to screening between 50 and 54 yr of age depending on societal willingness to pay.

Age Factors↗
PubMed2005

Estimating mean sojourn time and screening test sensitivity in breast cancer mammography screening: new results.

OBJECTIVE: To assess if new screening techniques, increased use of hormone replacement therapy, or the transition from breast cancer screening trials to large scale screening programmes may influence the average time in preclinical screening detectable phase (mean sojourn time [MST]) or screening test sensitivity (STS). SETTING: Screening and interval data for 395,188 women participating in the Norwegian Breast Cancer Screening Programme (NBCSP). METHODS: Weighted non-linear least-square regression estimates using a tree step Markov chain model, and a sensitivity analysis of the possible impact by opportunistic screening between ordinary breast cancer screening rounds. RESULTS: MST was estimated to 6.1 (95% confidence interval [CI] 5.1-7.0) years for women aged 50-59 years, and 7.9 (95% CI 6.0-7.9) years for those aged 60-69 years. Correspondingly, STS was estimated to 58% (95% CI 52-64 %) and 73 % (67-78 %), respectively. Simulations revealed that opportunistic screening may give a moderate estimation bias towards higher MST and lower STS. Assuming a probable 21% higher background incidence, due to increased hormone replacement therapy use, MST estimates decreased to 3.9 and 5.0 years for the two age groups, and STS increased to 75 and 85%. CONCLUSIONS: The new estimates indicate that screening detectable phase is longer than that found in previous mammography trials/programmes, but also that the sensitivity of the screening test is lower. Overall, the NBCSP detects more cancer cases than most previous trials/programmes.

Aged↗