Community-Based User Experience: Evaluating the Usability of Health Insurance Information With Immigrant Patients

User experience (UX), a common practice in corporate settings, is new for many nonprofit organizations. This case study details a community-based research project between nonprofit staff at a community health center and UX professionals to improve the design and usability of a document designed to help immigrant patients sign up for health insurance. UX professionals may need to adapt and be flexible with their efforts, but can offer valuable skills to community partners. Research questions: (1) What are the information needs and barriers faced by immigrant populations signing up for health insurance? (2) How does a usability study, adapted to meet the needs of immigrant populations, inform the design of a supplemental guidebook about health insurance? (3) What are the challenges and opportunities when engaging in community-based UX research projects? Situating the case: Other community-based research projects in technical communication and UX point to the need for a clear conceptualization of participation, a strong partnership with nonprofits, and the need to develop meaningful and actionable insights. Furthermore, when conducting studies with immigrant populations, the role of the translator on the research team is crucial. Methodology: As a community-based research project focused on the collaborative generation of practical knowledge, we conducted a usability study with 12 participants in two language groups, Chinese and Vietnamese, to evaluate the design and usability of a guidebook designed to provide guidance about enrolling in a health insurance plan. Data were analyzed to identify usability concerns and used to inform a second iteration of the guidebook. About the case: Immigrant populations struggle to sign up for health insurance for a variety of reasons, including limited English and health insurance literacy. As a result, a nonprofit community health center developed a guidebook to support immigrant populations. Version 1 of this guidebook was evaluat- d in a usability study, with results showing that users struggled to correctly choose a plan, determine their eligibility, and interpret abstract examples. As a result, Version 2 was designed to support the in-person experience, reduce visual complexity, and support patients\u27 key questions. Conclusions: Community-based UX collaborations can amplify the expertise of UX and nonprofit professionals. However, UX methods may need to be adapted in community-based projects to better incorporate local knowledge and needs

Practice of ALARA in the pediatric interventional suite

As interventional procedures have become progressively more sophisticated and lengthy, the potential for high patient radiation dose has increased. Staff exposure arises from patient scatter, so steps to minimize patient dose will in turn reduce operator and staff dose. The practice of ALARA in an interventional radiology (IR) suite, therefore, requires careful attention to technical detail in order to reduce patient dose. The choice of imaging modality should minimize radiation when and where possible. In this paper practical steps are outlined to reduce patient dose. Further details are included that specifically reduce operator exposure. Challenges unique to pediatric intervention are reviewed. Reference is made to experience from modern pediatric interventional suites. Given the potential for high exposures, the practice of ALARA is a team responsibility. Various measures are outlined for consideration when implementing a quality assurance (QA) program for an IR service

Gastric variceal bleeding caused by an intrahepatic arterioportal fistula that formed after liver biopsy: a case report and review of the literature

An intrahepatic arterioportal fistula is a rare cause of portal hypertension and variceal bleeding. We report on a patient with an intrahepatic arterioportal fistula following liver biopsy who was successfully treated by hepatectomy after unsuccessful arterial embolization. We also review the literature on symptomatic intrahepatic arterioportal fistulas after liver biopsy. A 48-year-old male with bleeding gastric varices and hepatitis B virus-associated liver cirrhosis was transferred to our hospital; this patient previously underwent percutaneous liver biopsies 3 and 6 years ago. Abdominal examination revealed a bruit over the liver, tenderness in the right upper quadrant, and splenomegaly. Ultrasonographic examination, computed tomography, and angiography confirmed an arterioportal fistula between the right hepatic artery and the right portal vein with portal hypertension. After admission, the patient suffered a large hematemesis and developed shock. He was treated with emergency transarterial embolization using microcoils. Since some collateral vessels bypassed the obstructive coils and still fed the fistulous area, embolization was performed again. Despite the second embolization, the collateral vessels could not be completely controlled. Radical treatment involving resection of his right hepatic lobe was performed. For nearly 6 years postoperatively, this patient has had no further episodes of variceal bleeding

Localização inicial da ponta de cateter central de inserção periférica (PICC) em recém-nascidos Localización inicial de la punta del catéter central de inserción periférica (PICC) en recién nacidos Initial placement of the peripherally inserted central catheter's tip in neonates

Estudo transversal com coleta prospectiva de dados, que objetivouidentificar o posicionamento inicial da ponta do cateter central de inserção periférica (PICC) e verificar a prevalência de sucesso de sua inserção em neonatos. Os dados foram coletados no berçário anexo à maternidade do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre março e setembro de 2006. Dos 37 neonatos submetidos à inserção do cateter PICC, a taxa de sucesso no procedimento foi de 72,3% (27 neonatos); destes, quatro (14,8%) estavam com as pontas dos cateteres alojadas nas veias axilar ou inominada; outros três (11,1%), alojadas em veia jugular. Estes cateteres foram removidos por desvio de trajeto. 13 (48,2%) estavam com as pontas alojadas em átrio direito, cujos cateteres foram tracionados para reposicionamento da ponta para a veia cava superior.<br>Estudio transversal con recolección prospectiva de datos. La finalidad fue identificar la posición inicial de la punta del catéter central de inserción periférica (PICC) y verificar la prevalencia de éxitos durante su introducción en neonatos. Los datos fueron recolectados en un servicio de neonatología anexo a la maternidad del Hospital de las Clínicas de la Facultad de Medicina de la Universidad de São Paulo, entre marzo y setiembre del 2006. De los 37 neonatos sometidos a introducción del catéter PICC, la tasa de éxito fue de 72.3% (27 neonatos), de ellos, cuatro (14.8%) estaban con las puntas de los catéteres alojadas en las venas axilar o no determinada, tres (11.1%) localizadas en la vena yugular. Siendo estos últimos retirados por desviación en su trayecto. El 48.2% (13) se encontraba con las puntas en el atrio derecho, siendo estos catéteres nuevamente posicionados en la vena cava superior.<br>This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC) and to verify the prevalence of success in inserting such catheters in neonates. The study was carried out in the neonatal care unit of Hospital das Clínicas, Universidade de São Paulo. Data were collected prospectively from March to September 2006. 37 neonates underwent PICC insertion were included in the study. The rate of success for this procedure was 72.3% (27 neonates). Of them, four (14.8%) had the catheter tips placed in the axilary or inominate veins. Three others (11.1%) had them placed in a jugular vein. When these catheters were removed, 13 (48.2%) catheter tip were placed in the right atrium, and they were relocated to the superior vena cava

Direct Effective Dose Calculations in Pediatric Fluoroscopy-Guided Abdominal Interventions with Rando-Alderson Phantoms – Optimization of Preset Parameter Settings

The aim of the study was to calculate the effective dose during fluoroscopy-guided pediatric interventional procedures of the liver in a phantom model before and after adjustment of preset parameters.Organ doses were measured in three anthropomorphic Rando-Alderson phantoms representing children at various age and body weight (newborn 3.5kg, toddler 10kg, child 19kg). Collimation was performed focusing on the upper abdomen representing mock interventional radiology procedures such as percutaneous transhepatic cholangiography and drainage placement (PTCD). Fluoroscopy and digital subtraction angiography (DSA) acquisitions were performed in a posterior-anterior geometry using a state of the art flat-panel detector. Effective dose was directly measured from multiple incorporated thermoluminescent dosimeters (TLDs) using two different parameter settings.Effective dose values for each pediatric phantom were below 0.1mSv per minute fluoroscopy, and below 1mSv for a 1 minute DSA acquisition with a frame rate of 2 f/s. Lowering the values for the detector entrance dose enabled a reduction of the applied effective dose from 12 to 27% for fluoroscopy and 22 to 63% for DSA acquisitions. Similarly, organ doses of radiosensitive organs could be reduced by over 50%, especially when close to the primary x-ray beam.Modification of preset parameter settings enabled to decrease the effective dose for pediatric interventional procedures, as determined by effective dose calculations using dedicated pediatric Rando-Alderson phantoms

Accuracy of flat panel detector CT with integrated navigational software with and without MR fusion for single-pass needle placement

PURPOSE: Fluoroscopic systems in modern interventional suites have the ability to perform flat panel detector CT (FDCT) with navigational guidance. Fusion with MR allows navigational guidance towards FDCT occult targets. We aim to evaluate the accuracy of this system using single-pass needle placement in a deep brain stimulation (DBS) phantom. MATERIALS AND METHODS: MR was performed on a head phantom with DBS lead targets. The head phantom was placed into fixation and FDCT was performed. FDCT and MR data sets were automatically fused using the integrated guidance system (iGuide, Siemens). A DBS target was selected on the MR data set. A 10cm, 19G needle was advanced by hand in a single pass using laser crosshair guidance. Radial error was visually assessed against measurement markers on the target and by a second FDCT. 10 needles were placed using CT-MR fusion and 10 needles were placed without MR fusion, targeting based solely off of the FDCT, with fusion steps repeated for every pass. RESULTS: Mean radial error was 2.75±1.39 mm as defined by visual assessment to the center of the DBS target and 2.80±1.43 mm as defined by FDCT to the center of the selected target point. There were no statistically significant differences in error between MR fusion and non-MR guided series. CONCLUSIONS: Single pass needle placement in a DBS phantom using FDCT guidance is associated with a radial error of approximately 2.5–3.0 mm at a depth of approximately 80 mm. This system could accurately target sub-centimeter intracranial lesions defined on MR