448 research outputs found
Automatic detection of actionable findings and communication mentions in radiology reports using natural language processing
__Objectives:__ To develop and validate classifiers for automatic detection of actionable findings and documentation of nonroutine communication in routinely delivered radiology reports.
__Me
Committed to Safety: Ten Case Studies on Reducing Harm to Patients
Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations
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User Interfaces for Patient-Centered Communication of Health Status and Care Progress
The recent trend toward patients participating in their own healthcare has opened up numerous opportunities for computing research. This dissertation focuses on how technology can foster this participation, through user interfaces to effectively communicate personal health status and care progress to hospital patients. I first characterize the design space for electronic information communication to patients through field studies conducted in multiple hospital settings. These studies utilize a combination of survey instruments, and low- and high-fidelity prototypes, including a document-editing prototype through which users can view and manage clinical data to automatically associate it with progress notes. The prototype, activeNotes, includes the first known techniques supporting clinical information requests directly within a document editor. A usage study with ICU physicians at New York-Presbyterian Hospital (NYP) substantiated our design and revealed how electronic information related to patient status and care progress is derived from a typical Electronic Health Record system. Insights gained from this study informed following studies to understand how to design abstracted, plain-language views suitable for patients. We gauged both patient and physician responses to information display prototypes deployed in patient rooms for a formative study exploring their design. Following my reports on this study, I discuss the design, development and pilot evaluations of a prototype Personal Health Record application providing live, abstracted clinical information for patients at NYP. The portal, evaluated by cardiothoracic surgery patients, is the first of its kind to allow patients to capture and monitor live data related to their care. Patient use of the portal influenced the subsequent design of tools to support users in making sense of online medication information. These tools, designed with nurses and pharmacists and evaluated by cardiothoracic surgery patients at NYP, were developed using topic modeling approaches and text analysis techniques. Embodied in a prototype called Remedy, they enable rapid filtering and comparison of medication-related search results, based on a number of website features and content topics. I conclude by discussing how findings from this series of studies can help shape the ongoing design and development of patient-centered technology
Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews
Background
Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings.
Objectives
Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.
Review methods
We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.
Results
We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.
Conclusions
In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.
Limitations
We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.
Future work
There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.
Funding
The National Institute for Health Research Health Services and Delivery Research programme
Sonographers' experiences regarding the responsibility of report writing
Abstract: Due to a shortage of radiologists worldwide, sonographers had to assume the extended role of reporting on their own findings. It is, therefore, important for sonographers to have adequate training and the necessary skills to perform an ultrasound examination, interpret the images and describe ultrasound findings correctly. Although this advanced practice comes with increased professional recognition and better remuneration, it is also associated with greater levels of responsibility, the possibility of malpractice lawsuits if pathology was missed, high professional insurance costs and the need for additional training. Although sonographers in South Africa are trained in image interpretation and report writing, there is paucity in the literature on how they experience this added responsibility. The purpose/aim of this qualitative phenomenological study was, thus, to explore and describe how sonographers in the Gauteng province experience the responsibility of report writing. This was done with the aim of developing guidelines to assist sonographers in the execution of this duty and further develop the skills to provide better structured and coherent reports. Data were collected at different neutral locations in the Gauteng province whereby sonographers who are responsible for writing reports on the ultrasound examinations which they conduct, were invited to participate in the study. Purposeful snowball sampling allowed for information rich participants to be recruited into the study. Subsequently, data were collected from a total of 13 female sonographers who took part in focus group discussions. In addition, reflective field notes were compiled by the researcher during and after each discussion session. The views and opinions of the sonographers were analysed using content analysis during which three main themes emerged: 1. The challenges and difficulties sonographers face during the report writing process 2. Positive experiences which provide sonographers with a sense of empowerment 3. The need for skills development as a way forward for future sonographers Guidelines, based on the data collected and informed by literature, were subsequently suggested to support sonographers in their report writing role and better prepare student sonographers for clinical practice. The guidelines are predominantly aimed at assisting a) higher education institutions with curriculum review and b) ultrasound departments in vi providing practice standards in terms of reporting writing c) encouraging sonographers to take accountability for improving their professional standing through research and publications.M.Tech. (Radiography
Case series of breast fillers and how things may go wrong: radiology point of view
INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging
breast due to breastfeeding or aging as well as small breast size. Recent years have shown the
emergence of a variety of injectable materials on market as breast fillers. These injectable
breast fillers have swiftly gained popularity among women, considering the minimal
invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know
that the procedure may pose detrimental complications, while visualization of breast
parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic
challenges. We present a case series of three patients with prior history of hyaluronic acid and
collagen breast injections.
REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening
shortness of breath, non-productive cough, central chest pain; associated with fever and chills
for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever
and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases
revealed non thrombotic wedge-shaped peripheral air-space densities.
The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2-
weeks duration. Previous collagen breast injection performed 1 year ago had impeded
sonographic visualization of the breast parenchyma. MRI breasts showed multiple non-
enhancing round and oval shaped lesions exhibiting fat intensity.
CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well
as limitations of imaging posed by breast fillers such that MRI is required as problem-solving
tool
Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan
INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar
ligament on MRI between male and female. The specific objectives are to assess the prevalence
of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and
signal homogeneity and to find differences in alar ligament signal intensity between male and
female. This study also aims to determine the association between the heights of respondents
with alar ligament signal intensity and dimensions.
MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner
Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar
ligament is depicted in 3 planes and the visualization and variability of the ligament courses,
shapes and signal intensity characteristics were determined. The alar ligament dimensions were
also measured.
RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial
planes. The orientations were laterally ascending in most of the subjects (60%), predominantly
oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar
ligament signal intensity between male and female respondents. No significant association was
found between the heights of the respondents with alar ligament signal intensity and dimensions.
CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal
plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as
depicted in our data shows that caution needs to be exercised when evaluating alar ligament,
especially during circumstances of injury
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