From the First Encounter: A Communication Program for High Volume, High Acuity Patient Care Locations

Effective communication is a true value to healthcare organizations. Far too many communication sessions are detrimental to patient health outcomes. National data and hospital records are proven information to suggest communication is a major barrier to overall patient satisfaction. Organizations struggle to increase market share and patient satisfaction with a likelihood to recommend because of poor communication by physician and nurses. The use of a strategic communication tool like AIDET plus the Promise can influence the improvement of an organization’s quality of care. This paper examines the use of AIDET plus the Promise as a strategic communication tool. High volume, high acuity patient care settings need the adaptation of a structured communication tool that can influence a positive health outcome. AIDET plus the Promise is a strategic communication tool that when used correctly can reduced anxiety, increased compliance whereby improved patient outcome, build trust and overall collaborative relationships. Findings in this research paper has provided enough evidence to suggest when AIDET plus the Promise is used as a guidance for strategic communication it can result in an overall improvement of patient health outcome and success of an organization. The findings have provided enough evidence to drive the development of a competency-based orientation toolkit to guide the implementation of AIDET plus the promise in a high volume, high acuity patient care setting

Magnetic Resonance imaging of tumour biomarkers in ovarian cancer

This thesis explores the application of novel magnetic resonance imaging (MRI) techniques to the evaluation of ovarian cancer. Diffusion kurtosis imaging (DKI), sodium MRI, magnetization transfer (MT) imaging, hyperpolarized carbon-13 MRI and magnetic resonance fingerprinting (MRF) were employed to image ovarian tumours in human subjects. The results of the imaging were compared to semi-quantitative measurements of histology and immunohistochemistry staining of tissue samples. It was found that DKI may predict responders to cytotoxic drugs and that sodium MRI and MT measure cellularity. Effective techniques to perform hyperpolarized carbon-13 MRI and MRF were also shown in a clinical setting, where MRF may improve imaging speed and the reproducibility of proton imaging and hyperpolarized carbon-13 MRI could provide unique in vivo metabolic information that differs from FDG-PET.Gates Cambridge Trust Cancer Research UK Wellcome Trust Cambridge Experimental Cancer Medicine Centre The Medical Research Council (MRC), Addenbrooke’s Charitable Trus

E-Commerce En México, Análisis Actual Desde La Perspectiva Del Consumidor

E-commerce will facilitate the entry of new companies into the markets, reduce transaction and production costs and make them more competitive, contributing to the economic growth of a state or country. Currently electronic commerce is in constant growth, both the volume of users and the number of commercial sites and technological advances have contributed to its accelerated development worldwide. Today technology allows us a wide sector that has to be exploited and taken advantage of from all its perspectives. They exist from social networks that are a way to promote themselves directly to end consumers, web pages used as virtual information offices, where opinion blogs, columns for satisfaction of needs, email as a means of communication between the offeror and the applicant are dealt with. and also, the opportunity to adapt a specific product to the needs of a client or a specific market. Internet commerce in Mexico is relatively young, it arises from the need to facilitate the purchase and sale of products or services by this means in a massive and intensive way and thus grow as a company and generate economic development in the country.El E-commerce facilitará la incursión de nuevas empresas a los mercados, reducirá los costos de transacción y producción y logrará que sean más competitivas, contribuyendo al crecimiento económico de un Estado o país. Actualmente el comercio electrónico se encuentra en constante crecimiento, tanto el volumen de usuarios como el número de sitios comerciales y los avances tecnológicos han contribuido en su acelerado desarrollo a nivel mundial. Hoy en día la tecnología es un amplio sector al cual se le tiene que explotar y aprovechar desde todas sus perspectivas. Existen desde las redes sociales que son una manera de promocionarse directamente a los consumidores finales, las páginas web utilizadas como oficinas de información virtuales, donde se ocupan blogs de opinión, columnas de satisfacción de necesidades, correo electrónico como medio de comunicación entre oferente y demandante y además la oportunidad de adaptación de un producto determinado a las necesidades de un cliente o de un mercado en específico. El comercio en Internet en México es relativamente joven, surge de la necesidad de facilitar la compra-venta de productos o servicios por este medio de manera masiva e intensiva y así crecer como empresa y generar el desarrollo económico en el país

Hyperpolarized carbon 13 MRI: clinical applications and future directions in oncology

Hyperpolarized carbon 13 MRI (13C MRI) is a novel imaging approach that can noninvasively probe tissue metabolism in both normal and pathologic tissues. The process of hyperpolarization increases the signal acquired by several orders of magnitude, allowing injected 13C-labeled molecules and their downstream metabolites to be imaged in vivo, thus providing real-time information on kinetics. To date, the most important reaction studied with hyperpolarized 13C MRI is exchange of the hyperpolarized 13C signal from injected [1-13C]pyruvate with the resident tissue lactate pool. Recent preclinical and human studies have shown the role of several biologic factors such as the lactate dehydrogenase enzyme, pyruvate transporter expression, and tissue hypoxia in generating the MRI signal from this reaction. Potential clinical applications of hyperpolarized 13C MRI in oncology include using metabolism to stratify tumors by grade, selecting therapeutic pathways based on tumor metabolic profiles, and detecting early treatment response through the imaging of shifts in metabolism that precede tumor structural changes. This review summarizes the foundations of hyperpolarized 13C MRI, presents key findings from human cancer studies, and explores the future clinical directions of the technique in oncology

Application of potassium ion deposition in determining the impact of support reducibility on catalytic activity of au/ceria-zirconia catalysts in CO oxidation, NO oxidation, and C3H8 combustion

The purpose of the study was to show how a controlled, subtle change of the reducibility of the support by deposition of potassium ions impacts the activity of gold catalysts. Since the activity of supported gold catalysts in carbon monoxide oxidation is known to strongly depend on the reducibility of the support, this reaction was chosen as the model reaction. The results of tests conducted in a simple system in which the only reagents were CO and O2 showed good agreement with the CO activity trend in tests performed in a complex stream of reagents, which also contained CH4, C2H6, C3H8, NO, and water vapor. The results of the X-ray Diffraction (XRD) studies revealed that the support has the composition Ce0.85Zr0.15O2, that its lattice constant is the same for all samples, and that gold is mostly present in the metallic phase. The reducibility of the systems was established based on Temperature Programmed Reduction (TPR) and in situ XRD measurements in H2 atmosphere. The results show that the low temperature reduction peak, which is due to the presence of gold, is shifted to a higher value by the presence of 0.3 at% potassium ions on the surface. Moreover, the increase of the potassium loading leads to a more pronounced shift. The T50 of CO oxidation in the simple model stream was found to exhibit an excellent linear correlation with the maximum temperature of the low temperature reduction peak of Au catalysts. This means that stabilizing oxygen with a known amount of potassium ions can be numerically used to estimate the T50 in CO oxidation. The results in the complex stream also showed a similar dependence of CO conversion on reducibility, though there was no substantial difference in the activity of the catalysts in other reactions regardless of the potassium loading. These studies have shown that the influence of potassium varies depending on the reaction, which highlights differences in the impact of reducibility and importance of other factors in these reactions

Door‐to‐Puncture: A Practical Metric for Capturing and Enhancing System Processes Associated With Endovascular Stroke Care, Preliminary Results From the Rapid Reperfusion Registry

Background: In 2011, the Brain Attack Coalition proposed door‐to‐treatment times of 2 hours as a benchmark for patients undergoing intra‐arterial therapy (IAT). We designed the Rapid Reperfusion Registry to capture the percentage of stroke patients who meet the target and its impact on outcomes. Methods and Results: This is a retrospective analysis of anterior circulation patients treated with IAT within 9 hours of symptom onset. Data was collected from December 31, 2011 to December 31, 2012 at 2 centers and from July 1, 2012 to December 31, 2012 at 7 centers. Short “Door‐to‐Puncture” (D2P) time was hypothesized to be associated with good patient outcomes. A total of 478 patients with a mean age of 68±14 years and median National Institutes of Health Stroke Scale (NIHSS) of 18 (IQR 14 to 21) were analyzed. The median times for IAT delivery were 234 minutes (IQR 163 to 304) for “last known normal‐to‐groin puncture” time (LKN‐to‐GP) and 112 minutes (IQR 68 to 176) for D2P time. The overall good outcome rate was 39.7% for the entire cohort. In a multivariable model adjusting for age, NIHSS, hypertension, diabetes, reperfusion status, and symptomatic hemorrhage, both short LKN‐to‐GP (OR 0.996; 95% CI [0.993 to 0.998]; P<0.001) and short D2P times (OR 0.993, 95% CI [0.990 to 0.996]; P<0.001) were associated with good outcomes. Only 52% of all patients in the registry achieved the targeted D2P time of 2 hours. Conclusions: The time interval of D2P presents a clinically relevant time frame by which system processes can be targeted to streamline the delivery of IAT care nationally. At present, there is much opportunity to enhance outcomes through reducing D2P

Primary results from the CLEAR study of a novel stent retriever with drop zone technology

Background: Challenges to revascularization of large vessel occlusions (LVOs) persist. Current stent retrievers have limited effectiveness for removing organized thrombi. The NeVa device is a novel stent retriever designed to capture organized thrombi within the scaffold during retrieval. Objective: To evaluate the safety and effectiveness of revascularization of acute LVOs with the NeVa device. Methods: Prospective, international, multicenter, single-arm, Investigational Device Exemption study to evaluate the performance of the NeVa device in recanalizing LVOs including internal carotid artery, M1/M2 middle cerebral artery, and vertebrobasilar arteries, within 8 hours of onset. Primary endpoint was rate of expanded Treatment in Cerebral Ischemia (eTICI) score 2b-3 within 3 NeVa passes, tested for non-inferiority against a performance goal of 72% with a -10% margin. Additional endpoints included first pass success and 90-day modified Rankin Scale (mRS) score 0-2. Primary composite safety endpoint was 90-day mortality and/or 24-hour symptomatic intracranial hemorrhage (sICH). Results: From April 2021 to April 2022, 139 subjects were enrolled at 25 centers. Median National Institutes of Health Stroke Scale (NIHSS) score was 16 (IQR 12-20). In the primary analysis population (n=107), eTICI 2b-3 within 3 NeVa passes occurred in 90.7% (97/107; non-inferiority P<0.0001; post hoc superiority P<0.0001). First pass eTICI 2b-3 was observed in 73.8% (79/107), with first pass eTICI 2b67-3 in 69.2% (74/107) and eTICI 2c-3 in 48.6% (52/107). Median number of passes was 1 (IQR 1-2). Final eTICI 2b-3 rate was 99.1% (106/107); final eTICI 2b67-3 rate was 91.6% (98/107); final eTICI 2c-3 rate was 72.9% (78/107). Good outcome (90-day mRS score 0-2) was seen in 65.1% (69/106). Mortality was 9.4% (13/138) with sICH in 5.0% (7/139). Conclusions: The NeVa device is highly effective and safe for revascularization of LVO strokes and demonstrates superior first pass success compared with a predicate performance goal. Trial registration number: NCT04514562