Effects of Patients' Affect on Adverse Procedural Events during Image-Guided Interventions.

PURPOSE: To assess how a patient's affect on presentation relates to the likelihood of adverse events during their subsequent interventional image-guided procedures. MATERIALS AND METHODS: A secondary analysis was performed of an existing dataset from a clinical trial with 230 patients who underwent percutaneous peripheral vascular and renal interventions and who had completed the positive affect (PA) negative affect (NA) schedule (PANAS) before their procedures. Summary PANAS scores were split over the median and used to classify the participants into those with high vs low PA and high vs low NA. Associations between affect and the absence or presence of adverse medical events were examined by two-sided Fisher exact tests. RESULTS: Patients with high baseline NA were significantly more likely to have adverse events during their procedures than those with low baseline NA (18% vs 8%; P = .030). High baseline PA was not associated with a significantly higher frequency of subsequent adverse events compared with low PA (15% vs 9%; P = .23). Patients with high NA requested and received significantly more sedative and opioid agents than those with low NA (2.0 vs 1.0 units requested [P = .0009]; 3.0 vs 1.0 units received [P = .0004]). PA levels did not affect medication use. CONCLUSIONS: High NA, but not PA, was associated with an increased likelihood of adverse events. Improving patients' NA before procedures seems a more suitable target than attempting to boost PA to improve the procedural experience.

Helping Children Cope with Medical Tests and Interventions.

Medical procedures and tests become a challenge when anxiety and pain make it difficult for the patient to cooperate or remain still when needed. Fortunately a short intervention with hypnoidal language at the onset of a procedure induces a positive and sustained change in the way pain and anxiety are processed. While anesthesia may appear to be a simple solution to eliminate pain, the adverse effects of pre-anesthesia anxiety on postoperative behavior and recovery are often not fully appreciated. This paper discusses options for self-hypnotic relaxation that are applicable to interactions with children. The high suggestibility of children makes it relatively easy to engage them in make-believe scenarios. Avoidance of negative suggestions is key in avoiding nocebo effects that may be difficult to overcome later. Once a child is immersed in his or her preferred scenario or hobby/activity of choice, environmental and procedural stimuli can be easily integrated in the imagery. Ego-strengthening metaphors that tie in features of strength, confidence, or resilience are particularly empowering. Even when children are fully under general anesthesia they may still have recall of what is said in the room and therefore caution in word choice should be maintained.

Understanding patient satisfaction ratings for radiology services.

OBJECTIVE: Under the Hospital Value-Based Purchasing Program of the Centers for Medicare & Medicaid Services, patient satisfaction accounts for 30% of the measures of and payments for quality of care. Understanding what drives patient satisfaction data and how the data are obtained, converted into scores, and formulated into rankings is increasingly critical for imaging departments. The objectives of this article are to describe the potential impact of patient satisfaction ratings on institutions and individuals, explain how patient satisfaction is rated and ranked, identify drivers that affect the ratings and rankings, and probe the resulting challenges unique to radiology departments. CONCLUSION: Research results indicate that training providers to make simple modifications in their language and behavior during patient care can significantly impact patient satisfaction, which, in turn, can impact both quality-of-care ratings and the bottom line of hospitals. Training providers is a simple and cost-effective way to potentiate the clinical expression of compassion into improvement of patient satisfaction and financial reward, a national trend that no one in the game can afford to ignore.

A Better Patient Experience Through Better Communication.

The transformation of healthcare from a seller's market to a consumer's market has pushed the element of patient satisfaction into the forefront of various medical facility evaluation tools, including those used by Medicare when weighing reimbursement to hospitals for patient care. Research has identified good communication skills to be a key factor in ensuring better patient outcomes, and nurturing patient satisfaction. Because of the growing amount of money at stake for patients' satisfaction with a facility, the communication skills of individual healthcare providers are bound to impact their employees' reimbursement, bonuses, and promotion options. Although the dangers of "poor communication," are evident: "poor communication" is a primary reason for filing a law suit in >80% of cases (Avery, 1985). Identifying the characteristics of "good communication" has been difficult. One factor that adds to the confusion is that research has found some long accepted codes of professional communication protocol to actually be counterproductive. Another factor that adds to the uncertainty is that accurate interpretations of some communication events are counterintuitive. Fortunately it has been possible to extract observable, proven, and teachable "good communication" behaviors from large-scale trials in the radiology department. The resultant Comfort Talk™ approach to communication includes rapid rapport techniques, patient-centered talking styles, and use of hypnotic language. This article overviews some of the Comfort Talk™ approaches to patients interaction and provides operational summaries of a sampling of specific Comfort Talk™ communication techniques, which nurses, technologists, and other healthcare workers can implement in their own practices.

The Impact of Scripted Self-Hypnotic Relaxation on the Periprocedural Experience and Anesthesiologist Sedation Use in the Pediatric Cardiac Catheterization Suite: A Prospective Randomized Controlled Trial.

Purpose: To assess the impact on children of self-hypnotic relaxation scripts read by trained staff prior to the induction of anesthesia and/or extubation on the periprocedural experience. Patients and Methods: A total of 160 children aged 7-18 years undergoing a cardiac catheterization intervention under general anesthesia were randomized into 4 groups: (1) a pre-procedure (PP-script) read prior to entering the procedural room, (2) a script read prior to extubation (PX-Script), (3) both PP- and PX-Scripts read and (4) no script read. Anxiety and pain were rated on self-reported 0-10 scales. The modified Yale Preoperative Anxiety Scale was used for preoperative anxiety. The effect of script reading was associated with outcomes by linear regression for continuous variables, and logistic regression for binary variables in two-sided tests at a significance level of 0.05. Results are given in odds ratios (OR) and 95% confidence intervals (CI). Results: Data were available for 158 patients. Reading the PP-Script prior to anesthesia was associated with a significant reduction in the use of intraoperative sedatives from 30% to 14% (OR 0.40; CI 0.18-0.88; p = 0.02) by the anesthesiologists, who were blinded to group attribution until extubation. This was despite the children not self-reporting significantly lower levels of anxiety or pain. The PX-Script did not change outcomes. Among groups, there was no significant difference in room time, postoperative recovery time and pain. Conclusion: Reading a PP-Script for guidance in self-hypnotic relaxation can result in less need for intravenous sedation in the judgment of the anesthesiologist, independent of the children's self-reported anxiety and pain. This raises interesting questions about subconscious patient-physician interactions affecting pain management. Clinicaltrialsgov Identifier: NCT02347748.

Does Patient Satisfaction Drive Volumes in Outpatient Magnetic Resonance Imaging?

OBJECTIVE: To help quantify the potential microeconomic impact of patient satisfaction in radiology, we tested the hypothesis that patient volume trends reflect patient satisfaction trends in outpatient magnetic resonance imaging (MRI). METHODS: Patient visits (N = 39,595) at distinct outpatient MRI sites within a university-affiliated hospital system during a 1-year period were retrospectively analyzed. Individual sites were grouped as having "decreasing," "stable," or "increasing" volume using an average quarterly volume change threshold of 5%. Based on Press Ganey outpatient services surveys, changes in satisfaction scores from the baseline quarter were calculated. Mood's median tests were applied to assess statistical significance of differences in satisfaction score improvements among the three volume trend designations during the 3 post-baseline fiscal quarters. RESULTS: Quarterly volume was stable at 6 sites, increased at 1 site (by 18%), and decreased at 2 sites (by 20%-24%). There was a statistically significant association between volume trend and net change in satisfaction scores for all 5 domains assessed on the Press Ganey survey: Overall assessment (P < 0.0001), Facilities (P = 0.026), Personal issues (P = 0.013), Registration (P = 0.0004), and Test or treatment (P < 0.0001), with median score changes generally higher at facilities with higher volume trends. DISCUSSION: It can be inferred that patient satisfaction drives volume in this scenario, whereas the converse relationship of volume adversely affecting satisfaction is not observed. Patient satisfaction and volume at MRI sites are interrelated, and patient experiences or perceptions of quality may influence decisions regarding what imaging sites are preferentially utilized.

Distress in the radiology waiting room.

PURPOSE: To assess the level of distress in women awaiting radiologic procedures. MATERIALS AND METHODS: In this institutional review board-approved and HIPAA-compliant study, 214 women between 18 and 86 (mean, 47.9) years of age completed the State Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Center for Epidemiologic Studies Depression Scale (CES-D), and Perceived Stress Scale (PSS) immediately prior to their procedures. One hundred twelve women awaited breast biopsy; 42, hepatic chemoembolization for cancer; and 60, uterine fibroid embolization. Data were analyzed with multivariate analysis of variance and post hoc Tukey tests. Results are reported as means and 95% confidence intervals (CIs). RESULTS: All three patient groups experienced abnormally high mean PSS, IES, and CES-D scores, but only the breast biopsy group had highly abnormal anxiety levels. Breast biopsy patients had a significantly higher mean STAI score of 48 (95% CI: 45, 50) than did women awaiting hepatic chemoembolization (mean score, 26; 95% CI: 22, 29; P < .001) and fibroid embolization (mean score, 24; 95% CI: 21, 27; P < .001). IES ratings did not differ significantly among the groups, with a mean score of 26 (95% CI: 23, 29) for breast biopsy patients, 23 (95% CI: 18, 28) for hepatic chemoembolization patients, and 23 (95% CI: 18, 27) for fibroid embolization patients. The CES-D score did not differ significantly among breast biopsy (mean score, 15; 95% CI: 13, 17), hepatic chemoembolization (mean score, 14; 95% CI: 11, 18), and fibroid embolization (mean score, 12; 95% CI: 9, 15) patients. PSS ratings of breast biopsy patients were significantly higher (mean score, 18; 95% CI: 16, 19) than those of hepatic chemoembolization patients (mean, 15; 95% CI: 13, 17; P < .01), but they were not significantly different from those of women awaiting fibroid embolization (mean, 16; 95% CI: 14, 18; P = .23). CONCLUSION: Uncertainty of diagnosis can be associated with greater stress than is awaiting more invasive and potentially risky treatment.

Managing distress, discomfort, and anxiety in imaging.

Positive patient interactions and experiences not only help the customer but also directly affect the bottom line. Waste of overhead can be limited by simply changing the way staff talks with patients. It is important to include rapid rapport skills and ways to positively shape the patients' experience right from the start instead of waiting and possibly having a procedure or scan disrupted. It "takes a village" to have a smooth transition in how communication is used throughout the department. A method of patient interaction called Comfort Talk was developed in which schedulers, receptionists, nurses, technologists, and physicians are extensively trained in advanced rapport skills and setting expectations.

The dosimetric benefit of in-advance respiratory training for deep inspiration breath holding is realized during daily treatment in left breast radiotherapy: A comparative retrospective study of serial surface motion tracking.

INTRODUCTION: A novel approach of in-advance preparatory respiratory training and practice for deep inspiration breath holding (DIBH) has been shown to further reduce cardiac dose in breast cancer radiotherapy patients, enabled by deeper (extended) DIBH. Here we investigated the consistency and stability of such training-induced extended DIBH after training completion and throughout the daily radiotherapy course. METHODS: Daily chestwall motion from real-time surface tracking transponder data was analysed in 67 left breast radiotherapy patients treated in DIBH. Twenty-seven received preparatory DIBH training/practice (prep Trn) 1-2 weeks prior to CT simulation, resulting in an extended DIBH (ext DIBH) and reduced cardiac dose at simulation. Forty had only conventional immediate pre-procedure DIBH instruction without prep Trn and without extended DIBH (non-Trn group). Day-to-day variability in chestwall excursion pattern during radiotherapy was compared among the groups. RESULTS: The average of daily maximum chestwall excursions was overall similar, 2.5 ± 0.6 mm for prep Trn/ext DIBH vs. 2.9 ± 0.8 mm for non-Trn patients (P = 0.24). Chestwall excursions beyond the 3-mm tolerance threshold were less common in the prep Trn/ext DIBH group (18.8% vs. 37.5% of all fractions within the respective groups, P = 0.038). Among patients with cardiopulmonary disease those with prep Trn/ext DIBH had fewer chestwall excursions beyond 3 mm (9.4% vs. 46.7%, P = 0.023) and smaller average maximum excursions than non-Trn patients (2.4 ± 0.3 vs. 3.0 ± 0.6 mm, P = 0.047, respectively). CONCLUSION: Similar stability of daily DIBH among patients with and without preparatory training/practice suggests that the training-induced extended DIBH and cardiac dose reductions were effectively sustained throughout the radiotherapy course. Training further reduced beyond-tolerance chestwall excursions, particularly in patients with cardiopulmonary disease.

Efficacy of a Self-Hypnotic Relaxation App on Pain and Anxiety in a Randomized Clinical Trial: Results and Considerations on the Design of Active and Control Apps.

Despite an explosion of mobile app offerings for management of pain and anxiety, the evidence for effectiveness is scarce. Placebo-controlled trials are the most desirable but designing inactive placebo apps can be challenging. For a prospective randomized clinical trial with 72 patients in a craniofacial pain center, we created an app with self-hypnotic relaxation (SHR) for use with iOS and Android systems. A placebo background audio (BA) app was built with the same look and functionality. Both iOS and Android SHR apps alone and in comparison to the BA group significantly reduced pain and anxiety during the waiting-room time. The Android BA app significantly reduced anxiety but not pain. The iOS BA app affected neither pain nor anxiety, functioning as an ideal placebo. Usage analysis revealed that different default approaches of the iOS and Android devices accounted for the difference in results.

Prevalence and Financial Impact of Claustrophobia, Anxiety, Patient Motion, and Other Patient Events in Magnetic Resonance Imaging.

Claustrophobia, other anxiety reactions, excessive motion, and other unanticipated patient events in magnetic resonance imaging (MRI) not only delay or preclude diagnostic-quality imaging but can also negatively affect the patient experience. In addition, by impeding MRI workflow, they may affect the finances of an imaging practice. This review article offers an overview of the various types of patient-related unanticipated events that occur in MRI, along with estimates of their frequency of occurrence as documented in the available literature. In addition, the financial implications of these events are discussed from a microeconomic perspective, primarily from the point of view of a radiology practice or hospital, although associated limitations and other economic viewpoints are also included. Efforts to minimize these unanticipated patient events can potentially improve not only patient satisfaction and comfort but also an imaging practice's operational efficiency and diagnostic capabilities.

Communication and Team Interactions to Improve Patient Experiences, Quality of Care, and Throughput in MRI.

Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients' awareness of what to expect during MRI and therefore mitigate anticipatory anxiety. Some patient interaction strategies to promote relaxation or calming effects are also discussed. Staff teamwork and staff training in communication and interpersonal skills are also described, along with literature evidence of effectiveness with respect to patient satisfaction and productivity endpoints. Attention to how radiologists, nurses, technologists, and other members of the radiology team interact with patients before or during the MRI scan could improve patients' motivation and ability to cooperate with the MRI scanning process as well as their subjective perceptions of the quality of their care. The topics discussed in this article are relevant not only to MRI operations but also to other clinical settings in which patient anxiety or motion represent impediments to optimal workflow.

Large-core breast biopsy: abnormal salivary cortisol profiles associated with uncertainty of diagnosis.

PURPOSE: To determine whether uncertainty of the diagnosis after large-core breast biopsy (LCBB) adversely affects biochemical stress levels. MATERIALS AND METHODS: This study was institutional review board approved and HIPAA compliant, and all patients gave written informed consent. One hundred fifty women aged 18-86 years collected four salivary cortisol samples per day for 5 days after LCBB. t Tests were used to compare diurnal cortisol slopes among three groups: patients who did not have a final diagnosis (uncertain group), patients who knew they had cancer (known malignant group), and patients who knew they had benign disease (known benign group). RESULTS: Women learned their diagnosis on days 1-6 (mean, day 2.4) after LCBB. Analysis was truncated at day 5, when the data from a sufficient number of patients from each group were available for meaningful analysis: 16 patients from the known malignant group, 37 from the known benign group, and 73 from the uncertain group, which totaled 126 patients. The mean cortisol slope for the women with an uncertain diagnosis (-0.092 ln [microg/dL]/hr; 95% confidence interval [CI]: -0.113 ln [microg/dL]/hr, -0.072 ln [microg/dL]/hr) was significantly flatter (less desirable) than that for the women who learned that they had benign disease (-0.154 ln [microg/dL]/hr; 95% CI: -0.197 ln [microg/dL]/hr, -0.111 ln [microg/dL]/hr; P = .014) but not significantly different from that for the women who learned that they had malignant disease (-0.110 ln [microg/dL]/hr; 95% CI: -0.147 ln [microg/dL]/hr, -0.073 ln [microg/dL]/hr; P = .421). CONCLUSION: Uncertainty about the final diagnosis after LCBB is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results.

In vitro analysis of downstream particulates with mechanical thrombectomy devices: comparison of 20-kHz sonothrombolytic and rotating dispersion wire systems.

PURPOSE: To assess the potential of macroembolization, the authors compared the downstream particulate profile generated with use of two thrombectomy devices, a 20-kHz ultrasound-based sonothrombolytic (ST) device and a rotating dispersion wire (RDW). MATERIALS AND METHODS: An arterial flow model was pressurized to 100 mm Hg and perfused with 1,000 mL/min normal saline. Tubing containing 7-mm x 30-cm bovine thrombus proximal to a 75% stenosis was inserted distal to a nonstenosed bypass. The effluent was passed successively through 1,000-, 500-, and 200-microm filters and a particle analyzer. The ST device and RDW were activated for 10 and 15 minutes, respectively, in randomized sequences of experimental sets with and without the use of 10-mg tissue-type plasminogen activator (tPA). Results are expressed as means and standard deviations of fraction of lysed clot in each category. RESULTS: The ST device produced significantly fewer particulates larger than 1,000 microm (1.3% +/- 1.4) than did the RDW (16.8% +/- 8.4, P < .001) and significantly more particulates smaller than 10 microm (90.7% +/- 7.6) than did the RDW (73.9% +/- 9.5; P < .001) at comparable thrombolytic efficacy (P = .982) and without significant effect from tPA (P = .988). There were no significant differences between particles measuring 500-1,000 microm (ST device: 0.3% +/- 0.3, RDW: 0.4% +/- 0.3; P = .653) and those measuring 10-199 microm (ST device: 7.5% +/- 7.5, RDW: 8.6% +/- 3.8; P = .624). The amount of particles on the 200-microm filter after RDW activation (0.4% +/- 0.3) exceeded those trapped after use of the ST device (0.1% +/- 0.1, P = .007) but contributed relatively little overall. CONCLUSIONS: In this in vitro model, the use of the ST device resulted in fewer large particulates than did the use of the RDW, with more clots being reduced to less than 10 microm.

Hemolysis comparison between the OmniSonics OmniWave Endovascular System and the Possis AngioJet in a porcine model.

PURPOSE: To compare the degree of hemolysis generated during use of the ultrasound-based OmniSonics OmniWave Endovascular System and the Possis AngioJet connected to an Xpeedior-6 catheter. MATERIALS AND METHODS: Twelve 64-145-kg Yorkshire pigs were used as the model because their weight, blood volume, and vessel diameters are comparable to that of adult humans. Six pigs were treated with the OmniWave and six with the AngioJet; half of the pigs in each group were treated in the contralateral iliofemoral arteries and half in the ipsilateral iliofemoral veins. Devices were activated for 10 minutes in patent vessels to represent a worst-case scenario for hemolysis generation. Plasma-free hemoglobin (PfHgb) levels, red blood cell counts, white blood cell (WBC) counts, and platelet counts were measured before and after the procedure, and PfHgb levels were measured every 2 minutes during treatment. RESULTS: The OmniWave generated significantly lower PfHgb levels than the AngioJet (average, 228 vs 1,367 mg/dL; P < .001). The location of activation (arterial vs venous) had no significant effect (P = .575). Compared with OmniWave use, AngioJet use was associated with significantly greater changes from pre- to posttreatment values in WBCs (P = .002), platelets (P = .004), and creatinine (P = .002). AngioJet use was associated with a significant postprocedure decrease in the WBC count (mean, -8,000/microl; 95% confidence interval [CI]: -3,830, -12,170; P = .004) and platelet count (mean, -72,000; 95% CI: -25,000, -120,000; P = .011). With the OmniWave device there were no significant differences between pre- and posttreatment WBC count (P = .127), platelet count (P = .493), and creatinine level (P = .317). CONCLUSIONS: The OmniWave generated approximately one-sixth of the hemolysis the AngioJet created. In addition, animals treated with the AngioJet exhibited a decrease in WBC and platelet counts.

Effects of age on responsiveness to adjunct hypnotic analgesia during invasive medical procedures.

OBJECTIVES: To assess the effects of age on responsiveness to self-hypnotic relaxation as an analgesic adjunct in patients undergoing invasive medical procedures. MATERIAL AND METHODS: Secondary data analysis from a prospective trial with 241 patients randomized to receive hypnosis, attention, and standard care treatment during interventional radiological procedures. Growth curve analyses, hierarchical linear regressions, and logistic regressions using orthogonal contrasts were used for analysis. Outcome measures were Hypnotic Induction Profile scores, self-reported pain and anxiety, medication use, oxygen desaturation < or =89%, and procedure time. RESULTS: Hypnotizability did not vary with age (p = .19). Patients receiving attention and hypnosis had greater pain reduction during the procedure (p = .02), with trends toward lower pain with hypnosis (p = .07); this did not differ by age. As age increased, patients experienced more rapid pain control with hypnosis (p = .03). There was more rapid anxiety reduction with attention and hypnosis (p = .03). Trends toward lower final anxiety were also observed with attention and hypnosis versus standard care (p = .08), and with hypnosis versus attention (p = .059); these relationships did not differ by age. Patients requested and received less medication and had less oxygen desaturation < or =89% with attention and hypnosis (p < .001); this did not differ by age. However, as age increased, oxygen desaturation was greater in standard care (p = .03). Procedure time was reduced in the attention and hypnosis groups (p = .007); this did not vary by age. CONCLUSIONS: Older patients are hypnotizable and increasing age does not appear to mitigate the usefulness of hypnotic analgesia during invasive medical procedures.

Hypnosis for acute distress management during medical procedures.

The use of hypnosis during medical procedures has a long-standing tradition but has been struggling for acceptance into the mainstream. In recent years, several randomized-controlled trials with sufficient participant numbers have demonstrated the efficacy of hypnosis in the perioperative domain. With the advancements of minimally invasive high-tech procedures during which the patient remains conscious, hypnotic adjuncts have found many applications. This article describes the procedural environment as well as pharmacologic and nonpharmacologic interventions to reduce distress. Current research findings, controversies in the literature, and safety considerations are reviewed. Implications for clinical practice and training as well as directions for future research are discussed. Obstacles and possible reasons for the slow acceptance of nonpharmacologic interventions, mind-body therapies, and patient-centered approaches are addressed.

Effects of Interpersonal Skills Training on MRI Operations in a Saturated Market: A Randomized Trial.

PURPOSE: The aim of this study was to assess the effects of team training on operational efficiency during outpatient MRI. METHODS: In this institutional review board-approved, HIPAA-compliant study, six MRI outpatient sites of a midwestern hospital system were randomized to serve as controls or have their teams trained in advanced communication skills. The fourth quarter of fiscal year 2015 was the trial baseline. The trial ended in the third quarter (Q3) of fiscal year 2016 (FY16). Equipment utilization (completed scans/available slots), hourly scan rates (total orders completed per machine per hour of operation), and no-show rates stratified by time were analyzed using the Cochran-Mantel-Haenszel method, with individual comparisons performed with Bonferroni correction. RESULTS: The study encompassed 27,425 MRI examinations. Overall volume peaked at baseline and then declined over the following quarters. Compared with baseline, untrained sites experienced significant drops in equipment utilization (P < .01 for the first quarter of FY16 and P < .0001 for the second quarter of FY16 and Q3 FY16), decreasing from 77% to 65% over the study period, corresponding to a decrease from 1.15 to 0.97 in hourly scan rates. For trained sites, these metrics showed no significant change, with maintenance of hourly scan rates of 1.23 and 1.27 and equipment utilization rates of 83% and 85% between baseline and Q3 FY16. No-show rates remained stable at trained sites but increased at untrained sites in the last two quarters (P < .05). Nationally benchmarked patient satisfaction percentile ranking gradually increased at trained sites from 56th at baseline to 70th and successively decreased at untrained sites from 66th to 44th. CONCLUSIONS: MRI outpatient facilities trained in advanced communication techniques may have more favorable operational efficiency than untrained sites in a saturated market.

Can words hurt? Patient-provider interactions during invasive procedures.

Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences. This practice is thought to be compassionate and helpful, but there is little data on the effect of such communicative behavior. This study assesses how such descriptions affect patients' pain and anxiety during medical procedures. The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3-arm prospective randomized trial assessing the efficacy of self-hypnotic relaxation. One hundred and fifty-nine videos of the standard care and attention control arms were reviewed. All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded. Patients' ratings of pain and anxiety on 0-10 numerical scales (0=No Pain, No Anxiety at All and 10=Worst Pain Possible, Terrified) after the painful event and/or sympathizing statement were the basis for this study. Warning the patient in terms of pain or undesirable experiences resulted in greater pain (P<0.05) and greater anxiety (P<0.001) than not doing so. Sympathizing with the patient in such terms after a painful event did not increase reported pain, but resulted in greater anxiety (P<0.05). Contrary to common belief, warning or sympathizing using language that refers to negative experiences may not make patients feel better. This conclusion has implications for the training in medical communication skills and suggests the need for randomized trials testing different patient-practioner interactions.

The effect of hyperoxygenation on T1 relaxation time in vitro.

RATIONALE AND OBJECTIVES: Ventilation with high oxygen (O2) concentrations has been shown to decrease T1 in blood and tissues of patients. This study aims to assess the effect of hyperoxygenation on the T1 relaxation time of blood and other physiologic solutions. MATERIALS AND METHODS: Varied gaseous mixtures of O2 and air between 21% and 100% O2 were created using an experimental circuit at room temperature, and used to saturate human blood, plasma, or normal saline. The samples were studied using an 8.45-Tesla magnetic resonance (MR) system and a 1.5-Tesla clinical MR scanner. RESULTS: MR spectroscopy at 8.45 Tesla showed that the percentage of O2 chosen for saturation correlated negatively with T1 (R2 = 1.00 for blood, 0.99 for plasma, and 1.00 for normal saline). The reduction in T1 between solutions saturated with 21% and 100% O2 was 487 milliseconds (22% of the baseline T1 value) for blood, 391 milliseconds (15%) for plasma and 622 milliseconds (19%) for saline. Similarly, MR measurements at 1.5 Tesla showed T1 reduction with increasing O2 concentration. Conclusion. The decreasing T1 in blood depends strongly on the fraction of dissolved O2 in solution and is largely independent of the hemoglobin content.