Patients as partners in radiology education: an innovative approach to teaching and assessing patient-centered communication

RATIONALE AND OBJECTIVES: Effective communication is essential for high quality care, yet little is known about radiologists' communication with patients, what constitutes "best communication practices," and how best to teach and evaluate it. We piloted educational strategies and an assessment instrument to teach and evaluate radiologists' communication skills. We focused on communication in the diagnostic mammography suite, where patient-radiologist interactions are often intense and stressful. MATERIALS AND METHODS: We adapted existing instruments to create a Radiology Communication Skills Assessment Tool (RCSAT). We piloted an educational program that included patients as teachers and raters of interpersonal and communication skills, and implemented a radiology objective structured clinical examination (OSCE). We measured radiology residents' self-assessed skills, confidence and stress, as well as patient-rated communication skills using the RCSAT. RESULTS: Residents' baseline self-assessed communication skills regarding abnormal mammograms were fair, confidence in their communication was minimal, and they found this communication stressful. Overall baseline communication skills, rated by patient-teachers using the RCSAT, were 3.62 on a 5-point scale (1 = poor to 5 = excellent). Analysis of post-OSCE debriefing comments yielded nine themes regarding effective radiology communication, as well as residents' reflections on the communication challenges they experience. The themes were integrated into subsequent RCSAT revisions. Residents' reflections were used to inform teaching workshops. CONCLUSION: Educational curricula on communication about difficult information can be implemented in radiology training programs. Radiology residents' performance can be assessed using a communication skills assessment tool during standardized patient-teacher encounters. Further research is necessary in this important domain.     

Evaluating medical students on radiology clerkships in a filmless environment: use of an electronic test prepared from PACS and digital teaching collection images

RATIONALE AND OBJECTIVES: The competency of medical students in radiology clerkships is traditionally evaluated with film images, projected slides of photographed films, or printed reproductions of films. As radiology departments switch to filmless imaging, it seemed appropriate to determine the feasibility of an electronic evaluation prepared directly from digital images. MATERIALS AND METHODS: The image-based portion of a multiple-choice final examination was prepared as a PowerPoint presentation that included images downloaded from the departmental picture archiving and communication system (PACS) or digital teaching collections. The images were downloaded as bitmap files, imported to Adobe Photoshop for image editing, converted to tagged image file format, and finally imported to PowerPoint, where they were combined with text to create 50 questions. A liquid crystal diode projector displayed the questions, with a timer set to advance them automatically. RESULTS: The examination was easy and inexpensive to prepare (no photography costs). In an initial survey of 25 students, 17 (71%) of 24 students rated the resolution of images as excellent and five (21%) as good. No student gave an image a poor rating. Students preferred that images cover at least 40%-50% of the slides, and most approved of a blue background. An original allowance of 30 seconds per slide was reported to be too fast; the interval was increased to 45 seconds. CONCLUSION: An electronic final examination for medical students, prepared with images downloaded from PACS or digital teaching collections, is feasible, easy to prepare, and cost-effective, and it provides an excellent display of test images.     

Investigation into the suitability of a portable psychometric device to be used in the field: an illicit drugs field investigation

RATIONALE: Driving performance is easily disrupted as a direct consequence of the use of alcohol, licit and illicit drugs. The use of such drugs has a high degree of correlation with increased accident risk. Europe wide research projects into drugged driving have called for the development of a portable objective device capable of screening those impaired through drug use which can be used at the roadside. OBJECTIVE: This study investigated the cognitive and psychomotor performance of a cohort of polydrug drug users in field conditions. Volunteers completed a psychometric test battery on a hand held device in music festival conditions. The test battery comprised a critical tracking task (CTT) and a sustained attention to response task (SART). Volunteers also took a breathanalyser and provided a saliva sample for a DOA screen. RESULTS: On the CTT significance was observed for tracking error following response to a peripheral stimulus in the high alcohol (>80 mg/100 ml) illicit drug group (p=0.0090) and approached significance for the low alcohol (<80 mg/100 ml) illicit drug group (p=0.088). For the SART, incorrect presses to the target stimulus was impaired for volunteers in both the low (<80 mg/100 ml) alcohol illicit drug group (p=0.0080) and the high alcohol (>80 mg/100 ml) illicit drug group (p=0.0415). Discrimination analysis demonstrated that the impairment device was able to discriminate between those individuals who had consumed neither alcohol nor drugs (94.12%), those in the low alcohol drug group (46.67%) and those in the high alcohol drug group (60.00%). CONCLUSION: It is possible to derive an impairment ratio. Further research will demonstrate whether this device could significantly contribute to drug driving detection and road traffic safety.     

Operating data and unsolved problems of the DICOM modality worklist: an indispensable tool in an electronic archiving environment

PURPOSE: We evaluated the efficacy of DICOM worklist software for radiological modalities from the viewpoint of risk management, to reduce mislabeled image data in an electronic archiving environment. We focused on the following five points: 1) the effectiveness of the DICOM modality worklist, 2) problems involving incorrect patient and image data, 3) the presence of incorrect profiles despite the transfer of patient profiles online via the DICOM worklist, 4) ways to eliminate entry failure, and 5) further examination even if data entry were correct. MATERIALS AND METHODS: Retrospective data of patient profiles with image data were evaluated both before and after installation of DICOM modality worklist management software at Sakai Municipal Hospital. All radiology modalities were connected to RIS terminals in which DICOM modality worklist software was installed. Patient profiles were transferred online from RIS terminals to the modalities. It was not necessary for technologists to type patient profiles in usual examinations. RESULTS: Before installing the DICOM modality worklist software, the number of data entry errors was 31 and the rate was 6.4% of 487 examinations. After installation, manual data entry occurred in 80 of 1,994 examinations. The number of data entry errors for patient profiles was two, and the rate was 0.1% of the total examinations (p < 0.0001). Before installing the DICOM modality worklist, two wrong patient IDs that corresponded to other existing patient IDs were typed into the modality. No patient IDs were mixed up after installation of the DICOM modality worklist (p = 0.0385). CONCLUSION: The DICOM worklist was indispensable to electronic archiving because it decreased incorrect patient profiles that corresponded to image data loss. This was effective in decreasing patient mix-ups that could lead to serious malpractice. Despite the DICOM worklist, however, some incorrect patient profiles remained as a result of manual typing errors. The reasons for manual typing included emergency examinations, paper-based operations, and system shutdown. Furthermore, the risk of patient mix-ups remained even if the patient profile was correct. To eliminate or decrease medical accidents, determining why accidents happen and ensuring better data confirmation are necessary.     

Endobronchial brachytherapy in the management of lung malignancies: 20 years of experience in an Australian center

ObjectivesManagement of end-stage lung cancers focuses on symptom control, requiring multimodality management. Endobronchial brachytherapy (EBB) is an evidence-based approach allowing safe delivery of clinically meaningful radiation doses. We provide a summary of treatment characteristics and clinical outcomes of EBB in a single center.Methods and MaterialsOur retrospective study examined all EBB procedures performed at St George Hospital, NSW, Australia, between 1997 and 2016. Patients received single-fraction brachytherapy treatment under procedural sedation, using either the pulsed-dose-rate or high dose-rate modality. Symptomatic response was noted at the 4- to 6-week followup consultation.ResultsNinety-two EBB procedures were identified in 83 patients, with 75 patients treated with pulsed-dose-rate and 17 with high-dose-rate. Clinical and/or radiological airway obstruction in a prior high-dose irradiated volume was the most common indication for treatment (85%). Sixty (72%) patients had a partial or complete response of symptoms. Patients with hemoptysis were more likely to respond than those with airway obstruction (92% vs. 70%; p = 0.036). There was no difference in clinical response between pulsed-dose-rate and high-dose-rate patients (p = 0.24). Median overall survival was 8 months, with a statistically significant difference in those with clinical response (4 vs. 9 months; p = 0.0101). No Grade >2 toxicities were recorded.ConclusionsWe present the largest Australian series of EBB to date. We continue to demonstrate that despite a variety of symptomatic presentations and histologies, EBB is an effective approach to the palliation of malignant lung lesions. Given its low risk of toxicity, EBB is recommended as an option in the palliative treatment of endobronchial malignancies.     

Diagnostic imaging and patient database managing systems: The integration of digital information in the experience of an intensive care center

AIM: To present our experience with integrating digital information on Intensive Care Unit patients (clinical data, laboratory findings, imaging, etc) to create electronic patient records. MATERIAL AND METHODS: Using the hospital Intranet, a connection was established between the Local area Network (LAN) of the Intensive Care Unit (ICU) and the Digital Imaging and Communications in Medicine (DICOM(R)) network of the Radiology Department allowing to receive, process and archive digital images locally at the ICU. Using the software RADclient-RADimage, the information received was managed by an electronic patient record system (DIGISTAT by UMS-Unterberger Medical Software, Florence). All the above software runs on Microsoft WindowsNT 4.0 platforms. RESULTS: Images of various kinds and formats (CT, MRI, etc.) pertaining to the ICU patients were semi-automatically handled and filed on a local server acting as a central databank. The images were then included in the electronic patient record and made available to the end user who could view them using either web technologies (hypertexts were automatically generated that could be viewed through the widely available World Wide Web browsers) or specific viewing utilities supplied with DIGISTAT . DISCUSSION AND CONCLUSIONS: For the intensivist, the handling and filing of data on hospitalised or discharged patients for treatment or research purposes involves having to process large amounts of information. Furthermore, in the event of patients being re-admitted to the unit, it is crucial to have ready access to all the information regarding previous hospital stays, including diagnostic images, to avoid the need for time-consuming searches through the hospital s paper-based archives. The possibility to access clinical information and diagnostic images using a single computer programme proved to be useful both for evaluating the patient s conditions immediately after the imaging procedure and for monitoring the patient s progress over time by comparing the different diagnostic images and imaging procedures. This pilot experience could be seen to provide the basic know-how for applying the method in the future Emergency Department of the A. Gemelli Hospital in Rome.     

Knee joint simulator: an anatomical reconstruction of the joint surfaces and of the ligamentous structures of the knee joint for teaching purposes

A knee joint simulator with anatomical reconstruction of the joint surfaces and of the ligamentous structures was built for teaching purposes. With this simulator it is possible to demonstrate the anatomy, physiology and kinematics of knee ligaments, to teach and learn how to conduct ligamentous instability tests and to demonstrate the effect of knee ligament reconstructive surgery. Received: 11 March 1998 Accepted: 12 May 1998     

Predictors of rehabilitation intention and behavior following anterior cruciate ligament surgery: an application of the Theory of Planned Behavior

This study was guided by the Theory of Planned Behavior (TPB) to assess the predictors of rehabilitation intention and adherence following anterior cruciate ligament (ACL) reconstructive surgery in athletes. Participants (n=87; mean age=28.95±7.7 years) volunteered to participate following their first post-surgery physiotherapy session and completed the baseline measures of intention, attitudes, subjective norm, perceived behavioral control, self-efficacy, participation level, sport and age. At follow-up, 48 participants returned completed rehabilitation diaries detailing adherence behavior every 2 weeks during an 8-week period. Results indicated that there was no significant difference in rehabilitation behavior at weeks 2, 4, 6 or 8. A multivariate analysis of covariance indicated that sport type, sport level, intention and intention(2) significantly predicted rehabilitation behavior, although the strength of relationship varied across the weeks. Self-efficacy was a significant predictor of intention. These findings suggest that adherence behavior is predicted by sport type, participation level and curvilinearly by intention to adhere. Intention to adhere can be positively associated with enhanced self-efficacy. The study has highlighted issues that practitioners should be aware of when encouraging rehabilitation adherence. However, the TPB provided a poor fit for understanding adherence behavior in this setting.     

Outcomes of embolization of bone tumors in the pelvic and shoulder girdles: Initial experience

Purpose

To assess the effectiveness of transarterial embolization of bone tumors as preoperative technique to reduce blood loss or as a curative method in bone tumors of shoulder and pelvic girdles.

Role of the virtual reality simulator (ScanTrainer) as a multidisciplinary training tool in transvaginal ultrasound: A systematic review and narrative synthesis

ObjectivesThis systematic review investigates the role of the ScanTrainer as a virtual reality training simulator and its impact on the scanning skills in transvaginal ultrasound of novice ultrasound practitioners.Key findingsAfter searching ten databases for studies incorporating the simulator as a part of the learning/training process, ten out of 684 studies met the eligibility criteria and were included in the review. The analysis of the textual findings using narrative synthesis approach resulted in four themes: Validation (assessment of the validity of the simulator), Learning (using the simulator as a learning tool), Perspectives (the perceptions of participants trained on the simulator), and Transferable skills (skills developed on the simulator can transfer to clinical practice).ConclusionAlthough literature indicates that the simulator is valuable as a training/learning tool, there is insufficient evidence of measurable effects on clinical practice of simulator usage by different healthcare professions.     

Ultrasound guided Core Biopsy, Fine Needle Aspiration Cytology and Surgical Excision Biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: an eleven year experience

Introduction

This study aims to review our 11 year experience of diagnosing metastatic squamous cell carcinoma presenting as head and neck lumps. The techniques of Ultrasound guided Core Biopsy (USCB), Fine Needle Aspiration Cytology (FNAC) and Surgical Excision Biopsy (SEB) are compared.

Materials and methods

All patients with metastatic squamous cell carcinoma (SCC) involving the lymph nodes of the head and neck or parotid gland, diagnosed at Eastbourne District General Hospital between January 1998 and November 2009 were identified. The following data items were collated: biopsy location (e.g. cervical lymph node or parotid), any history of likely primary SCC and site, type of biopsy used to establish a conclusive diagnosis (index diagnostic technique), previous biopsies, the technique and their results, subsequent histology results.

Results

A total of 90 patients were diagnosed with metastatic squamous cell carcinoma. The index diagnostic technique was USCB in 48 patients, FNAC in 29 and SEB in 13. In 72 (80%) patients the index biopsy was the sole tissue sample taken prior to surgery or other treatment. The remaining 18 patients underwent a total of 22 previous biopsies prior to the index biopsy. 95% (21/22) of these previous biopsies were non-definitive FNAC and 5% (1/22) was a non-definitive USCB. FNACs also demonstrated the highest non-diagnostic rate (42%). The accuracy of USCB and FNAC in correlating with final histopathology was 97% and 85% respectively.

Conclusions

USCB demonstrates excellent results in the diagnosis of metastatic SCC in the head and neck with higher accuracy and greater reliability than FNAC.     

Postmortem computed tomography and magnetic resonance imaging in a case of terminal-stage small cell lung cancer: an experience of autopsy imaging in tumor-related death

We report a case of terminal-stage small-cell lung cancer with multiple metastases in which postmortem computed tomography and magnetic resonance imaging (collectively called “autopsy imaging”) were performed and correlated with conventional autopsy findings. In this case, autopsy imaging provided contemporaneous data that supported conventional autopsy findings. Autopsy imaging revealed the process of primary tumor growth, changes in metastatic lesions, and occurrences of new metastases in the terminal stage and made it easier to understand the clinical course of the patient. The usefulness of autopsy imaging after traumatic death, sudden death from natural causes, or congenital anomaly has been reported. Here, we attempted a preliminary study of its use in the detection of death due to tumor. Our results indicated that autopsy imaging provides useful information in cancer-related death and may be an alternative when conventional autopsy cannot be performed.     

Placement of hemoparin-coated stents in the iliac arteries: Early experience and midterm results in 28 patients

Purpose

Aim was to determine immediate results and mid-term outcome of the hemoparin-coated (HC) stainless-steel stent (camouflage coating) in the treatment of occlusive lesions of the iliac arteries.

Materials and methods

Twenty-eight patients were prospectively treated with the use of a HC stent between January 2007 and March 2010. Clinical examination and color-doppler ultrasound were performed at 1, 3, 6 and 12 months, CT angiography (CTA) or MR angiography (MRA) at 12 months. Indication for treatment was a high-grade stenosis of the common iliac and/or external iliac artery.

Results

Successful placement was achieved in all patients. Significant decrease in translesional pressure gradient (>10 mmHg) was measured in 27 patients (96%). In one patient, proximal dissection occurred without flow limitation. A minor complication (small access site hematoma) occurred in one patient (4%). Two patients (7%) were lost to follow-up. After 12 months, stent patency in CTA, MRA and ultrasound was 100%. 20 patients (77%) experienced an initial improvement of at least one clinical stage. In one patient (4%), mild intimal hyperplasia without significant stenosis was observed. In three patients (12%), proximal or distal stenosis occurred. A non-significant increase of mean ankle-brachial index (ABI) after treatment was measured (0.85 ± 0.27 vs. 0.75 ± 0.22, respectively; p = 0.328).

Conclusions

The use of HC stents in patients with iliac artery occlusive disease may lead to a lower rate of intimal hyperplasia and thus to increased patency rates even in heavily calcified vessels. However, large-scale prospective trials have to be performed to evaluate the long-term patency rates of the HC coated stents.     

How teaching on the care of the victim of sexual violence alters undergraduate medical students' awareness of the key issues involved in patient care and their attitudes to such patients

Sexual violence is known to be highly prevalent, albeit the majority of incidents are not reported to the authorities. It is therefore likely that medical students will encounter very many patients who have experienced sexual violence during their postgraduate careers, although this history may never be disclosed to them. Numerous highly regarded sources have advocated for the inclusion of instruction on the care of the victim of sexual violence in undergraduate medical curricula. Moreover, there has been a call for research to measure the effectiveness of educational strategies addressing the issue of sexual violence at undergraduate level. We present an evaluation of the effectiveness of a reproducible teaching session on care of the victim of sexual violence appropriate for undergraduate medical students, looking specifically at alterations in students' awareness of the key issues involved in patient care and their attitudes to such patients. This research demonstrates that such an educational intervention significantly enhances undergraduate medical students' awareness of the issues involved in patient care and their insight in to myths surrounding sexual violence.     

Blended learning in medical education: use of an integrated approach with web-based small group modules and didactic instruction for teaching radiologic anatomy

RATIONALE AND OBJECTIVES: To describe the development of and assess student satisfaction with a blended learning method for teaching radiologic anatomy that integrates web-based instruction with small group and didactic teaching. MATERIALS AND METHODS: In 2002 the teaching of radiologic anatomy to first-year medical students was changed from group learning (20-30 students with a preceptor and films at a viewbox) to a blended learning model that included a brief didactic introduction followed by small group (7-8 students) web-based structured learning modules with rotating lab instructors. In 2003 the modules were changed to include self-study cases prior to the lab, follow-up cases, and twice-weekly optional review sessions. Students and lab instructors were surveyed for their response to the content and design of the sessions. RESULTS: Course surveys in 2001, with a response rate of 84%, showed 58 negative comments regarding inconsistency between various instructors. Individual response rates for 2002 for radiologic anatomy teaching sessions (RadLab) surveys ranged from 56%-81%, dropping as the course progressed. All RadLabs were rated "very useful" or "useful," except the cardiovascular lab, which was not designed as an interactive module. In 2003, after redesign of the cardiovascular lab in the same format as the other labs, all RadLabs were rated 2.4 or better (useful). CONCLUSION: An integration of computers with small and large group didactic instruction allow optimal use of faculty, conform to accepted theories of adult learning, and are well-accepted by students.     

CT and MR findings in synovial chondromatosis of the temporo-mandibular joint: Our experience and review of literature

Objective

To compare Computed Tomography (CT) and Magnetic Resonance (MR) features and their diagnostic potential in the assessment of Synovial Chondromatosis (SC) of the Temporo-Mandibular Joint (TMJ).

Materials and methods

Eight patients with symptoms and signs compatible with dysfunctional disorders of the TMJ underwent CT and MR scan. We considered the following parameters: soft tissue involvement (disk included), osteostructural alterations of the joints, loose bodies and intra-articular fluid. These parameters were evaluated separately by two radiologists with a “double blinded method” and then, after agreement, definitive assessment of the parameters was given. CT and MR findings were compared.

Results

Histopathological results showed metaplastic synovia in all patients and therefore confirmed diagnosis of SC. MR resulted better than CT in the evaluation of all parameters except the osteostructural alterations of the joints, estimated with more accuracy by CT scan.

Conclusions

CT scan is excellent to define bony surfaces of the articular joints and flogistic tissue but it fails in the detection of loose bodies when these are not yet calcified. MR scan therefore is the gold standard when SC is suspected since it can visualize loose bodies at early stage and also evaluate disk condition and eventual extra-articular tissues involvement. The use of T2-weighted images and contrast medium allows identifying intra-articular fluid, estimating its entity and discriminating from sinovial tissue.