Interventions to improve patient experience in mammography: a scoping review protocol.

OBJECTIVE: The objective of this review is to map the global evidence on interventions aiming to enhance the patient experience during mammography examination. INTRODUCTION: Mammography is the examination of choice to detect breast cancer, which is the most common malignant condition among women globally. However, this examination can cause psychological distress, discomfort, and pain for patients. To limit these negative experiences, and to promote patient engagement in diagnostic and screening examinations, some interventions have been tested in clinical practice. Each intervention has key differing features that need to be explored in a scoping review. This mapping will help inform mammography professionals and researchers. INCLUSION CRITERIA: This review will consider studies that focus on women, men, transgender, nonbinary, or intersexual persons undergoing diagnostic or screening mammography. It will consider studies evaluating interventions and reporting data on the patient experience. These interventions may, for instance, be related to the information provided, breast compression, relaxation, medication, or physical environment. The review will also describe the outcomes related to patient experience (eg, anxiety, pain, discomfort). METHODS: The search strategy will aim to find published and unpublished studies and will be conducted in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and ProQuest Dissertation and Theses. Furthermore, three registries will be searched for ongoing studies. This review will be conducted following JBI methodology, utilizing the three-step search strategy with two independent reviewers performing study selection and data extraction. The results, frequencies, and conceptual categories will be presented in a tabular and narrative summary. SCOPING REVIEW REGISTRATION: Open Science Framework ( https://osf.io/fn865/ ).

Contrast media extravasations in patients undergoing computerized tomography scanning: a systematic review and meta-analysis of risk factors and interventions.

OBJECTIVE: To identify risk factors and interventions preventing or reducing contrast medium extravasation. INTRODUCTION: Computed tomography (CT) is a radiological examination essential for the diagnosis and monitoring of many diseases. It is often performed with the intravenous (IV) injection of contrast agents. Use of these products can result in a significant complication, extravasation, which is the accidental leakage of IV material into the surrounding tissue. Patients may feel a sharp pain and skin ulceration or necrosis may develop. INCLUSION CRITERIA: This review considered studies that included patients (adults and children) undergoing a CT with IV administration of contrast media. The risk factors considered were patient demographics, comorbidities and medication history. This review also investigated any strategies related to: contrast agent, injection per se, material used for injection, apparatus used, healthcare professionals involved, and patient risk assessment performed by the radiology personnel. The comparators were other interventions or usual care. This review investigated randomized controlled trials and non-randomized controlled trials. When neither of these were available, other study designs, such as prospective and retrospective cohort studies, case-control studies and case series, were considered for inclusion. Primary outcomes considered were: extravasation frequency, volume, severity and complications. METHODS: The databases PubMed, CINAHL, Embase, the Cochrane Register of Controlled Trials, Web of Science PsycINFO, ProQuest Dissertations and Theses A&I, TRIP Database and ClinicalTrials.gov were searched to find both published and unpublished studies from 1980 to September 2016. Papers were assessed by two independent reviewers for methodological validity using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Data were extracted using the standardized data extraction tool from JBI SUMARI. In one case, quantitative data from two cohort studies were pooled in a statistical meta-analysis. However, generally, statistical pooling was not possible due to heterogeneity of the interventions, populations of interest or outcomes. Accordingly, the findings have been presented in narrative form. RESULTS: Fifteen articles were selected from a total of 2151 unique studies identified. Two were randomized controlled trials and 13 were quasi-experimental and observational studies. The quality of these studies was judged to be low to moderate. Some patient characteristics, such as female sex and inpatient status, appeared to be risk factors for extravasation. Additionally, injection rate, venous access site and catheter dwelling time could affect the volume extravasated. Preliminary studies seemed to indicate the potential of extravasation detection accessories to identify extravasation and reduce the volume extravasated. The other interventions either did not result in significant reduction in the frequency/volume of extravasation, or the results were mixed across the studies. CONCLUSIONS: The majority of the studies included in this review evaluated the outcomes of extravasation frequency and volume. Given the quality of the primary studies, this systematic review identified only potential risk factors and interventions. It further highlighted the research gap in this area and the importance of conducting trials with solid methodological designs.

Optimal slice thickness for object detection with longitudinal partial volume effects in computed tomography.

Longitudinal partial volume effects (z-axial PVE), which occur when an object partly occupies a slice, degrade image resolution and contrast in computed tomography (CT). Z-axial PVE is unavoidable for subslice objects and reduces their contrast according to their fraction contained within the slice. This effect can be countered using a smaller slice thickness, but at the cost of an increased image noise or radiation dose. The aim of this study is to offer a tool for optimizing the reconstruction parameters (slice thickness and slice spacing) in CT protocols in the case of partial volume effects. This optimization is based on the tradeoff between axial resolution and noise. For that purpose, we developed a simplified analytical model investigating the average statistical effect of z-axial PVE on contrast and contrast-to-noise ratio (CNR). A Catphan 500 phantom was scanned with various pitches and CTDI and reconstructed with different slice thicknesses to assess the visibility of subslice targets that simulate low contrast anatomical features present in CT exams. The detectability score of human observers was used to rank the perceptual image quality against the CNR. Contrast and CNR reduction due to z-axial PVE measured on experimental data were first compared to numerical calculations and then to the analytical model. Compared to numerical calculations, the simplified algebraic model slightly overestimated the contrast but the differences remained below 5%. It could determine the optimal reconstruction parameters that maximize the objects visibility for a given dose in the case of z-axial PVE. An optimal slice thickness equal to three-fourth of the object width was correctly proposed by the model for nonoverlapping slices. The tradeoff between detectability and dose is maximized for a slice spacing of half the slice thickness associated with a slice width equal to the characteristic object width.

Sensor Monitoring of Physical Activity to Improve Glucose Management in Diabetic Patients: A Review.

Diabetic individuals need to tightly control their blood glucose concentration. Several methods have been developed for this purpose, such as the finger-prick or continuous glucose monitoring systems (CGMs). However, these methods present the disadvantage of being invasive. Moreover, CGMs have limited accuracy, notably to detect hypoglycemia. It is also known that physical exercise, and even daily activity, disrupt glucose dynamics and can generate problems with blood glucose regulation during and after exercise. In order to deal with these challenges, devices for monitoring patients' physical activity are currently under development. This review focuses on non-invasive sensors using physiological parameters related to physical exercise that were used to improve glucose monitoring in type 1 diabetes (T1DM) patients. These devices are promising for diabetes management. Indeed they permit to estimate glucose concentration either based solely on physical activity parameters or in conjunction with CGM or non-invasive CGM (NI-CGM) systems. In these last cases, the vital signals are used to modulate glucose estimations provided by the CGM and NI-CGM devices. Finally, this review indicates possible limitations of these new biosensors and outlines directions for future technologic developments.

Diagnostic test accuracy: methods for systematic review and meta-analysis.

Systematic reviews are carried out to provide an answer to a clinical question based on all available evidence (published and unpublished), to critically appraise the quality of studies, and account for and explain variations between the results of studies. The Joanna Briggs Institute specializes in providing methodological guidance for the conduct of systematic reviews and has developed methods and guidance for reviewers conducting systematic reviews of studies of diagnostic test accuracy. Diagnostic tests are used to identify the presence or absence of a condition for the purpose of developing an appropriate treatment plan. Owing to demands for improvements in speed, cost, ease of performance, patient safety, and accuracy, new diagnostic tests are continuously developed, and there are often several tests available for the diagnosis of a particular condition. In order to provide the evidence necessary for clinicians and other healthcare professionals to make informed decisions regarding the optimum test to use, primary studies need to be carried out on the accuracy of diagnostic tests and the results of these studies synthesized through systematic review. The Joanna Briggs Institute and its international collaboration have updated, revised, and developed new guidance for systematic reviews, including systematic reviews of diagnostic test accuracy. This methodological article summarizes that guidance and provides detailed advice on the effective conduct of systematic reviews of diagnostic test accuracy.

Precision and Accuracy of Measurements on CT Scout View.

OBJECTIVES: The purposes of this study were to (1) investigate the limits of measurements on scout view in three computed tomography axes, x, y and z and (2) develop a model to provide better understanding of measurement accuracy. METHODS: For the first objective, anteroposterior and lateral scout views of a Catphan phantom 200 mm in diameter and length were acquired with a GE scanner at 21 different table heights. Phantom measurements on scout view were performed by two experienced readers. The comparison of their measures provided estimation of precision. The accuracy was assessed by determining the bias, calculated as the difference between the values measured on scout view and the real phantom size. Second, a model was developed investigating the relationship between the dimensions of the object, its image, and the table height. This relationship was tested on our data. RESULTS: Scout view measurements were precise, with less than 0.53% difference between readers. In addition, small biases of about 1 mm were detected in the z-axis, whatever the table height. In the other axes, serious biases from -13 to +73 mm were measured. Furthermore, at isocentre, overestimations up to 7 mm were shown. The results also indicated that biases in scout view measurements are because of the geometrical projection related to the object-detector distance. CONCLUSIONS: Measurements in the table movement axis are precise and accurate, conferring to scout views an added value for preoperative planning in orthopedic surgery.

MediCoordination: a practical approach to interoperability in the Swiss health system.

Interoperability and data exchange between partners in the health sector is seen as one of the important domains that can improve care processes and in the long run also decrease costs of the health care system. Data exchange can assure that the data on the patient are as complete as possible avoiding potential mistreatments, and it can avoid double examinations if the data required are already available. On the other hand, health data is a sensible point for many people and strong protection needs to be implemented to protect patient data against misuse as well as tools to let the patient manage his/her own data. Many countries have eHealth initiatives in preparation or already implemented. However, health data exchange on a large scale still has a fairly long way to go as the political processes for global solutions are often complicated. In the MediCoordination project a pragmatic approach is selected trying to integrate several partners in health care on a regional scale. In parallel with the Swiss eHealth strategy that is currently being elaborated by the Swiss confederation, particularly medium-sized hospitals and external partners are targeted in MediCoordination to implement concrete added-value scenarios of information exchange between hospitals and external medical actors.