Effect of a communication lecture tutorial on breast imaging trainees' confidence with challenging breast imaging patient interactions.

PURPOSE: The aim of the study was to evaluate the effect of a one-hour lecture based communication curriculum on breast imaging trainees' confidence in communicating with patients in a challenging communication setting such as delivering bad news or radiologic error disclosure. METHODS: 12 breast imaging trainees from an academic fellowship program completed questionnaires before and after a communication tutorial. A four breast imaging specific scenario questionnaire assessed confidence by asking the trainees to rank agreement with statements related to their attitude in those specific settings. 12-month follow-up questionnaire was sent to the graduating fellows assessing their -overall confidence in patient communication, the contribution of the curriculum to their self-perceived communication skill and their likelihood in disclosing a radiologic error to a patient. RESULTS: All trainees completed the pre and post lecture questionnaire. After the communication tutorial, all trainees reported increased confidence in communicating with patients in a variety of challenging settings with pre lecture survey mean confidence score of 38/98 and post lecture survey mean score of 85.3/98, P = 0.003. Three of eight trainees who completed the 12-month follow up questionnaire reported confidence in their communication skills and reported that the tutorial significantly contributed to their communication skill development. All three agreed that they would be likely to disclose a medical error should they encounter it in their future career. CONCLUSIONS: A limited resource one-hour lecture communication tutorial provides effective communication training for breast imaging fellows and is a promising part of a breast imaging curriculum.

Abdominal Aortic Aneurysm Repair Readmissions and Disparities of Socioeconomic Status: A Multistate Analysis, 2007-2014.

OBJECTIVE(S): To determine differences in perioperative abdominal aortic aneurysm (AAA) repair outcomes based on patient sociodemographics. DESIGN: A retrospective analysis of patient hospitalization and discharge records. SETTING: All-payer patients in nonpsychiatric hospitals in New York, Maryland, Florida, Kentucky, and California. PARTICIPANTS: A total of 92,028 patients from the State Inpatient Databases Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality from January 2007 to December 2014 (excluding California, ending December 2011) who underwent AAA repair. INTERVENTIONS: Data extraction and univariate and multivariate regression analysis. MEASUREMENTS AND MAIN RESULTS: Patients in the highest income quartile were less likely to be readmitted compared with those in the poorest income quartile at both 30 days (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.83-0.95) and 90 days (OR 0.85, 95% CI 0.81-0.91). Hospital readmissions were significantly greater for African American (OR 1.32, 95% CI 1.20-1.44) and Hispanic patients (OR 1.14, 95% CI 1.04-1.25) compared with white patients 30 days after AAA repair. These results were consistent 90 days after AAA repair. Patients insured with Medicare (OR 1.25, 95% CI 1.17-1.34) or Medicaid (OR 1.46, 95% CI 1.30-1.64) were more likely to be readmitted after both time points as compared with those with private insurance. The authors also found that patients with lower income, African American and Hispanic patients, and patients without private insurance were all significantly more likely to undergo emergency rather than elective repair. CONCLUSIONS: Lower socioeconomic status is shown to be an independent risk factor for increased postoperative morbidity in AAA repair. The authors believe the present study demonstrates the importance of socioeconomic status as a factor in perioperative risk stratification.

Spinal trauma in Tanzania: current management and outcomes.

OBJECTIVE: Spinal trauma is a major cause of disability worldwide. The burden is especially severe in low-income countries, where hospital infrastructure is poor, resources are limited, and the volume of cases is high. Currently, there are no reliable data available on incidence, management, and outcomes of spinal trauma in East Africa. The main objective of this study was to describe, for the first time, the demographics, management, costs of surgery and implants, treatment decision factors, and outcomes of patients with spine trauma in Tanzania. METHODS: The authors retrospectively reviewed prospectively collected data on spinal trauma patients in the single surgical referral center in Tanzania (Muhimbili Orthopaedic Institute [MOI]) from October 2016 to December 2017. They collected general demographics and the following information: distance from site of trauma to the center, American Spinal Injury Association Impairment Scale (AIS), time to surgery, steroid use, and mechanism of trauma and AOSpine classification and costs. Surgical details and complications were recorded. Primary outcome was neurological status on discharge. The authors analyzed surgical outcome and determined predicting factors for positive outcome. RESULTS: A total of 180 patients were included and analyzed in this study. The mean distance from site of trauma to MOI was 278.0 km, and the time to admission was on average 5.9 days after trauma. Young males were primarily affected (82.8% males, average age 35.7 years). On admission, 47.2% of patients presented with AIS grade A. Most common mechanisms of injury were motor vehicle accidents (28.9%) and falls from height (32.8%). Forty percent of admitted patients underwent surgery. The mean time to surgery was 33.2 days; 21.4% of patients who underwent surgery improved in AIS grade at discharge (p = 0.030). Overall, the only factor associated with improvement in neurological status was undergoing surgery (p = 0.03) and shorter time to surgery (p = 0.02). CONCLUSIONS: This is the first study to describe the management and outcomes of spinal trauma in East Africa. Due to the lack of referral hospitals, patients are admitted late after trauma, often with severe neurological deficit. Surgery is performed but generally late in the course of hospital stay. The decision to perform surgery and timing are heavily influenced by the availability of implants and economic factors such as insurance status. Patients with incomplete deficits who may benefit most from surgery are not prioritized. The authors' results suggest that surgery may have a positive impact on patient outcome. Further studies with a larger sample size are needed to confirm our results. These results provide strong support to implement evidence-based protocols for the management of spinal trauma.

Association Between 2 Measures of Cognitive Instrumental Activities of Daily Living and Their Relation to the Montreal Cognitive Assessment in Persons With Stroke.

OBJECTIVES: To explore the relation between a computer adaptive functional cognitive questionnaire and a performance-based measure of cognitive instrumental activities of daily living (C-IADL) and to determine whether the Montreal Cognitive Assessment (MoCA) at admission can identify those with C-IADL difficulties at discharge. DESIGN: Prospective cohort study. SETTING: Acute inpatient rehabilitation unit of an academic medical center. PARTICIPANTS: Inpatients (N=148) with a diagnosis of stroke (mean age, 68y; median, 13d poststroke) who had mild cognitive and neurological deficits. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Admission cognitive status was assessed by the MoCA. C-IADL at discharge was assessed by the Executive Function Performance Test (EFPT) bill paying task and Activity Measure of Post-Acute Care (AM-PAC) Applied Cognition scale. RESULTS: Greater cognitive impairment on the MoCA was associated with more assistance on the EFPT bill paying task (ρ=-.63; P<.01) and AM-PAC Applied Cognition scale (ρ=-.43; P<.01). This relation was nonsignificant for higher MoCA scores and EFPT bill paying task scores. The AM-PAC Applied Cognition scale and the EFPT bill paying task had low agreement in classifying functional performance (Cohen's κ=.20). A receiver operating characteristic curve identified optimal MoCA cutoff scores of 20 and 21 for classifying EFPT bill paying task status and AM-PAC Applied Cognition scale status, respectively. For values above 20 and 21, sensitivity increased whereas specificity decreased for classifying functional deficits. Approximately one third of the participants demonstrated C-IADL deficits on at least 1 C-IADL measure at discharge despite having a MoCA score of ≥26 at admission. CONCLUSIONS: Questionnaire and performance-based methods of assessment appear to yield different estimates of C-IADL. Low MoCA scores (<20) are more likely to identify those with C-IADL deficits on the EFPT bill paying task. The results suggest that C-IADL should be assessed in those who have mild or no cognitive difficulties at admission.