Case series demonstrating in vivo MR safety of stainless steel (Chinese/Ring) IUDs.

Intrauterine devices (IUDs) are one of the most common forms of long-term contraception used by patients around the world. Many studies have been performed over the past few decades demonstrating the safety of many common hormonal and metallic intrauterine devices in Magnetic Resonance (MR) imaging; however, the stainless steel ring IUD (often termed the "Chinese" IUD) is still considered MR Unsafe. This device was used in the 1980s and 1990s in China, where as many as 60 million women in China were using an IUD by 1988, and approximately 90% of those were stainless steel ring IUDs. In a major metropolitan area hospital such as ours with a large immigrant population, we encounter females with this ring IUD several times a year. As this population ages, the need for medical care (and concomitantly, MR imaging) is projected to increase. The purpose of this case review is to examine the imaging and clinical course of patients with stainless-steel ring intrauterine devices who safely received 1.5T Brain MR scans at our institution for clinically necessary diagnostic imaging.

Development and Pilot Evaluation of a Decision Aid for Small Kidney Masses.

OBJECTIVE: To develop and pilot test a patient decision aid (DA) describing small kidney masses and risks and benefits of treatment for the masses. METHODS: An expert committee iteratively designed a small kidney mass DA, incorporating evidence-based risk communication and informational needs for treatment options and shared decision-making. After literature review and drafting content with the feedback of urologists, radiologists, and an internist, a rapid qualitative assessment was conducted using two patient focus groups to inform user-centered design. In a pilot study, 30 patients were randomized at the initial urologic consultation to receive the DA or existing institutional patient educational material (PEM). Preconsultation questionnaires captured patient knowledge and shared decision-making preferences. After review of the DA and subsequent clinician consultation, patients completed questionnaires on discussion content and satisfaction. Proportions between arms were compared using Fisher exact tests, and decision measures were compared using Mann-Whitney tests. RESULTS: Patient informational needs included risk of tumor growth during active surveillance and ablation, significance of comorbidities, and posttreatment recovery. For the DA, 84% of patients viewed all content, and mean viewing time was 20 min. Significant improvements in knowledge about small mass risks and treatments were observed (mean total scores: 52.6% DA versus 22.3% PEM, P < .001). DA use also increased the proportion of patients discussing ablation (66.7% DA versus 18.2% PEM, P = .02). Decision satisfaction measures were similar in both arms. DISCUSSION: Patients receiving a small kidney mass DA are likely to gain knowledge and preparedness to discuss all treatment options over standard educational materials.

Outcomes of Incidental Lung Nodules With Structured Recommendations and Electronic Tracking.

OBJECTIVE: To evaluate the impact of structured recommendations on follow-up completion for incidental lung nodules (ILNs). METHODS: Patients with ILNs before and after implementation of structured Fleischner recommendations and electronic tracking were sampled randomly. The cohorts were compared for imaging follow-up. Multivariable logistic regression was used to assess appropriate follow-up and loss to follow-up, with independent variables including use of structured recommendations or tracking, age, sex, race, ethnicity, setting of the index test (inpatient, outpatient, emergency department), smoking history, and nodule features. RESULTS: In all, 1,301 patients met final inclusion criteria, including 255 patients before and 1,046 patients after structured recommendations or tracking. Baseline differences were found in the pre- and postintervention groups, with smaller ILNs and younger age after implementing structured recommendations. Comparing pre- versus postintervention outcomes, 40.0% (100 of 250) versus 29.5% (309 of 1,046) of patients had no follow-up despite Fleischner indications for imaging (P = .002), and among the remaining patients, 56.6% (82 of 145) versus 75.0% (553 of 737) followed up on time (P < .001). Delayed follow-up was more frequent before intervention. Differences postintervention were mostly accounted for by nodules ≤8 mm in the outpatient setting (P < .001). In multivariable analysis, younger age, White race, outpatient setting, and larger nodule size showed significant association with appropriate follow-up completion (P < .015), but structured recommendations did not. Similar results applied for loss to follow-up. DISCUSSION: Consistent use of structured reporting is likely key to mitigate selection bias when benchmarking rates of appropriate follow-up of ILN. Emergency department patients and inpatients are at high risk of missed or delayed follow-up despite structured recommendations.

Detecting illicit opioid content on Twitter.

INTRODUCTION AND AIMS: This article examines the feasibility of leveraging Twitter to detect posts authored by people who use opioids (PWUO) or content related to opioid use disorder (OUD), and manually develop a multidimensional taxonomy of relevant tweets. DESIGN AND METHODS: Twitter messages were collected between June and October 2017 (n = 23 827) and evaluated using an inductive coding approach. Content was then manually classified into two axes (n = 17 420): (i) user experience regarding accessing, using, or recovery from illicit opioids; and (ii) content categories (e.g. policies, medical information, jokes/sarcasm). RESULTS: The most prevalent categories consisted of jokes or sarcastic comments pertaining to OUD, PWUOs or hypothetically using illicit opioids (63%), informational content about treatments for OUD, overdose prevention or accessing self-help groups (20%), and commentary about government opioid policy or news related to opioids (17%). Posts by PWUOs centered on identifying illicit sources for procuring opioids (i.e. online, drug dealers; 49%), symptoms and/or strategies to quell opioid withdrawal symptoms (21%), and combining illicit opioid use with other substances, such as cocaine or benzodiazepines (17%). State and public health experts infrequently posted content pertaining to OUD (1%). DISCUSSION AND CONCLUSIONS: Twitter offers a feasible approach to identify PWUO. Further research is needed to evaluate the efficacy of Twitter to disseminate evidence-based content and facilitate linkage to treatment and harm reduction services.