Abstract Purpose The aim of this study was to determine whether direct verbal communication of results by a radiologist affected follow-up compliance rates for probably benign breast imaging ...findings. Methods This study was institutional review board approved and HIPAA compliant. A retrospective search identified all patients from January 1, 2010 to December 31, 2010 who had breast findings newly assessed as probably benign (BI-RADS category 3). Patients were categorized by whether the radiologist or the technologist verbally communicated the result and follow-up recommendation. Patient adherence to 6-, 12-, and 24-month follow-up imaging recommendations was recorded. Results Compliance data were available for 770 of 819 patients in the study. Overall compliance was 83.0% (639 of 770) for 6-month examinations, 68.1% (524 of 770) for 6- and 12-month examinations, and 57.4% (442 of 770) for 6-, 12-, and 24-month examinations. For patients who initially underwent diagnostic mammography alone, there was no significant difference in compliance between those who had and those who did not have radiologist-patient communication (6 months, 81.9% vs 80.8% P = .83; 6 and 12 months, 70.8% vs 67.3% P = .58; 6, 12, and 24 months, 54.2% vs 58.4% P = .53). For patients who initially underwent diagnostic mammography alone versus ultrasound with or without diagnostic mammography, there was no significant difference in compliance (6 months, 81.1% vs 84.3% P = .24; 6 and 12 months, 68.1% vs 68.0% P = .96; 6, 12, and 24 months, 57.4% vs 57.4% P = .00). Conclusions High initial compliance was achieved by radiologist or technologist verbal communication of findings and recommendations. Direct communication by the radiologist did not increase compliance compared with communication by a technologist.
Background Chest CT scans are commonly used to clinically assess disease severity in patients presenting with pulmonary sarcoidosis. Despite their ability to reliably detect subtle changes in lung ...disease, the utility of chest CT scans for guiding therapy is limited by the fact that image interpretation by radiologists is qualitative and highly variable. We sought to create a computerized CT image analysis tool that would provide quantitative and clinically relevant information. Methods We established that a two-point correlation analysis approach reduced the background signal attendant to normal lung structures, such as blood vessels, airways, and lymphatics while highlighting diseased tissue. This approach was applied to multiple lung fields to generate an overall lung texture score (LTS) representing the quantity of diseased lung parenchyma. Using deidentified lung CT scan and pulmonary function test (PFT) data from The Ohio State University Medical Center's Information Warehouse, we analyzed 71 consecutive CT scans from patients with sarcoidosis for whom simultaneous matching PFTs were available to determine whether the LTS correlated with standard PFT results. Results We found a high correlation between LTS and FVC, total lung capacity, and diffusing capacity of the lung for carbon monoxide ( P < .0001 for all comparisons). Moreover, LTS was equivalent to PFTs for the detection of active lung disease. The image analysis protocol was conducted quickly (< 1 min per study) on a standard laptop computer connected to a publicly available National Institutes of Health ImageJ toolkit. Conclusions The two-point image analysis tool is highly practical and appears to reliably assess lung disease severity. We predict that this tool will be useful for clinical and research applications.
INTRODUCTION:Despite the widespread use of opioids in pain management, there are currently no evidence-based guidelines for the treatment of postoperative pain with opioids. Although other surgical ...specialties have begun researching their pain prescribing patterns, there has yet to be an investigation to unravel opioid prescribing patterns among plastic surgeons.
METHODS:Survey Monkey was used to sample the American Society of Plastic Surgeons (ASPS) members regarding their opioid prescribing practice patterns. The survey was sent randomly to 50% of ASPS members. Respondents were randomized to 1 of 3 different common elective procedures in plastic surgerybreast augmentation, breast reduction, and abdominoplasty.
RESULTS:Of the 5,770 overall active ASPS members, 298 responses (12% response rate) were received with the following procedure randomization results106 for breast augmentation, 99 for breast reduction, and 95 for abdominoplasty. Overall, 80% (N = 240) of respondents used nonnarcotic adjuncts to manage postoperative pain, with 75.4% (N = 181) using nonnarcotics adjuncts >75% of the time. The most commonly prescribed narcotics were Hydrocodone with Acetaminophen (Lortab, Norco) and Oxycodone with Acetaminophen (Percocet, Oxycocet) at 42.5% (N = 116) and 38.1% (N = 104), respectively. The most common dosage was 5 mg (80.4%; N = 176), with 48.9% (N = 107) mostly dispensing 20–30 tablets, and the majority did not give refills (94.5%; N = 207).
CONCLUSIONS:Overall, plastic surgeons seem to be in compliance with proposed American College of Surgeon’s opioid prescription guidelines. However, there remains a lack of evidence regarding appropriate opioid prescribing patterns for plastic surgeons.
Bladder perforation is a potentially life-threatening condition, typically occurring after genitourinary trauma. The vast majority of cases are secondary to blunt abdominal trauma resulting in pelvic ...fractures, with motor vehicle accidents the commonest cause. There are however a wide range of underlying causes, including iatrogenic injuries and spontaneous perforations. This case series of 4 unusual cases of bladder perforations presenting to a single center under the same consultant within a 3-month period aims to highlight the diverse nature of patients who can present with bladder perforations and the different management options available.
To compare foveal hypoplasia and the appearance of the ellipsoid zone (EZ) at the fovea in patients with genetically confirmed achromatopsia (ACHM) and blue cone monochromacy (BCM).
Retrospective, ...multicenter observational study.
Molecularly confirmed patients with ACHM (n = 89) and BCM (n = 33).
We analyzed high-resolution spectral-domain OCT (SD-OCT) images of the macula from patients with BCM. Three observers independently graded SD-OCT images for foveal hypoplasia (i.e., retention of ≥1 inner retinal layers at the fovea), and 4 observers judged the integrity of the EZ at the fovea, based on an established grading scheme. These measures were compared with previously published data from the patients with ACHM.
Presence of foveal hypoplasia and EZ grade.
Foveal hypoplasia was significantly more prevalent in ACHM than in BCM (P < 0.001). In addition, we observed a significant difference in the distribution of EZ grades between ACHM and BCM, with grade II EZ being by far the most common phenotype in BCM (61% of patients). In contrast, patients with ACHM had a relatively equal prevalence of EZ grades I, II, and IV. Grade IV EZ was 2.6 times more prevalent in ACHM compared with BCM, whereas grade V EZ (macular atrophy) was present in 3% of both the ACHM and BCM cohorts.
The higher incidence of foveal hypoplasia in ACHM than BCM supports a role for cone activity in foveal development. Although there are differences in EZ grades between these conditions, the degree of overlap suggests EZ grade is not sufficient for definitive diagnosis, in contrast to previous reports. Analysis of additional OCT features in similar cohorts may reveal differences with greater diagnostic value. Finally, the extent to which foveal hypoplasia or EZ grade is prognostic for therapeutic potential in either group remains to be seen, but motivates further study.
Objective Success rates vary for the retrieval of inferior vena cava filters (IVCFs). The optimal retrieval time and factors influencing retrieval success remain unproven. This study aims to ...determine optimal time and evaluate factors related to successful IVCF retrieval. Methods An institutional prospectively maintained database was reviewed for all IVCF retrieval attempts from 2006 to 2012. Patient demographics, comorbidities, indications for procedure, placement technique, IVCF type, presence of angulation, and time to retrieval were evaluated with respect to success or failure of retrieval. Statistical analyses ( t -test, χ2 , correlations, and Kaplan-Meier plots) were performed comparing successful and unsuccessful retrievals. Results Of 121 attempted IVCF retrievals, 92 (76%) were successful and 29 (24%) were unsuccessful. There were no significant differences between the successful and unsuccessful attempts in terms of patient demographics, comorbidities, indications for procedure, placement technique, or IVCF type, which included 93 Celect (77%) and 28 Gunther Tulip (23%). Time since IVCF placement was significantly different ( P = .025) between the successful and unsuccessful retrieval groups (medians were 105 7-368 and 162 43-379 days, respectively). Time since IVCF placement greater than 117 days correlated significantly with unsuccessful IVCF retrieval (R = 0.218; P = .017; odds ratio, 2.88; P = .02). Angulation greater than 20 degrees on anteroposterior radiograph was noted in seven of 29 (24%) unsuccessful retrievals compared with seven of 92 (8%) successful retrievals and was significant ( P = .012). Conclusions Cook Gunther Tulip and Celect IVCF retrieval is most likely to be successful within 3 to 4 months of placement. Unsuccessful retrieval attempts are more likely to occur when IVCF position is angulated.
PDF
