Flexible transbronchial optical frequency domain imaging smart needle for biopsy guidance.

Transbronchial needle aspiration (TBNA) is a procedure routinely performed to diagnose peripheral pulmonary lesions. However, TBNA is associated with a low diagnostic yield due to inappropriate needle placement. We have developed a flexible transbronchial optical frequency domain imaging (TB-OFDI) catheter that functions as a "smart needle" to confirm the needle placement within the target lesion prior to biopsy. The TB-OFDI smart needle consists of a flexible and removable OFDI catheter (430 µm dia.) that operates within a standard 21-gauge TBNA needle. The OFDI imaging core is based on an angle polished ball lens design with a working distance of 160 µm from the catheter sheath and a spot size of 25 µm. To demonstrate the potential of the TB-OFDI smart needle for transbronchial imaging, an inflated excised swine lung was imaged through a standard bronchoscope. Cross-sectional and longitudinal OFDI results reveal the detailed network of alveoli in the lung parenchyma suggesting that the TB-OFDI smart needle may be a useful tool for guiding biopsy acquisition to increase the diagnostic yield.

Patient satisfaction: examine your practice through their eyes.

In an environment of constant change, effective management decisions are harder to make. Physicians and clinic managers often miss valuable information from one key group--the patients. Their input builds a framework for sound solutions. The most efficient, unbiased collection method is a patient satisfaction study. With guidance from some one who is experienced in survey design and handling, physicians and managers will find these studies are easy to administer, are tools for learning and help build patient loyalty. Effectively designed studies give proportion to issues raised by patients. This information helps physicians and managers make good decisions on practice style, operations and service delivery. In the two case studies of primary care practices included in this article, the physician partners had very different issues of concern than the patients did. Without the studies, the physicians might have made poor decisions on the future of their clinics. Insurance providers recommend regular satisfaction studies to measure quality improvements, a clinic's strengths and weaknesses, and the patients' expectations. Patients are your lifetime partners and have valuable information for the survival of a practice. They help define where a practice is and where it should be.