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Background: The diagnosis of cancer can increase the risk of anxiety severe enough to interfere with treatment compliance, quality of life, and treatment outcomes (Lee et al., 2017). Anxiety is a common problem in patients scheduled for a procedure, and their level of anxiety increases as the procedure date approaches (Musa et al., 2020); pre-procedural anxiety is observed in hepatocellular carcinoma patients scheduled for liver ablation treatment. There is currently a lack of standardized education provided to patients about liver ablation treatment, which may contribute to patients’ anxiety.Objectives: To test the effectiveness of a pre-procedural video educational tool to reduce patient anxiety and increase knowledge in hepatocellular carcinoma patients in an interventional radiology clinic setting.Methods: This was a quasi-experimental, single-arm study, with a pre-test/post-test. Participant recruitment was based on a convenience sample. Inclusion criteria included: patients ages 18 and older; have biopsy-proven HCC or have a liver mass suspicious for HCC based on LI-RADS criteria imaging; no prior liver ablation treatment within three months of study onset. Exclusion criteria included patients under the age of 18 or those who have had prior liver ablation treatment within the last three months of study onset. Participants watched a 7:04 minutes video and completed a 40-item State-Trait Anxiety Inventory and 10-item Knowledge Questionnaire before and after the video intervention to assess changes in anxiety and knowledge. Demographic variables evaluated included age, gender, education, and primary language.Results: There were 16 participants who met inclusion criteria. The state anxiety scores were significantly lower after the intervention (Md = 33.50, n = 16) compared to before (Md = 47.50, n = 16), z = - 2.67, p = 0.009, with a medium effect size, r = 0.47. The trait anxiety scores did not show sufficient evidence for a difference after the intervention (Md = 40.00, n = 16) compared to before (Md = 39.50, n = 16), z = - 0.71, p = 0.50, with a small effect size, r = 0.13. The knowledge scores were significantly higher after the intervention (Md = 9.00, n = 16) compared to before (Md = 2.00, n = 16), z = - 3.53, p = 0.0005, with a large effect size, r = 0.62. A nonparametric bootstrap and nonparametric permutation test also showed evidence for a difference in mean between the distributions of the state anxiety and knowledge pre- and post-intervention scores.Conclusion: The results of this study showed evidence for the effectiveness of video education in decreasing anxiety and increasing knowledge in hepatocellular carcinoma patients. A standardized pre-procedural video educational tool can be a useful practice across all interventional radiology departments as it is associated with improved quality of care and positive health outcomes.

Objectives This study sought to evaluate cardiac computed tomography (CCT) findings and their clinical impact among patients being considered for transcatheter mitral valve replacement (TMVR). Background CCT is used to evaluate whether patients are candidates for TMVR, but limited data exist on the yield of such tests. Methods Patients referred for pre-procedural CCT for TMVR planning in the context of failing mitral bioprosthetic valves, annuloplasty rings, and severe native valve disease with annular calcification were included in this study. CCT findings were analyzed to evaluate for suitability for TMVR. In the subset of patients who underwent TMVR, echocardiographic and procedural characteristics were recorded. Results Among 80 patients who underwent pre-procedural CCT, the mean age was 71.8 ± 11.4 years, 60% were women, and the mean Society of Thoracic Surgeon score was 9.4 ± 6.7. Most cases were referred for valve-in-native annular calcification planning (n = 43), followed by valve-in-valve (n = 29), and valve-in-ring procedures (n = 8). A total of 51 (64%) patients did not undergo TMVR, 37 of whom had high-risk features identified on CCT. The most common reason for exclusion was related to large annular size, followed by heightened risk of left ventricular outflow tract (LVOT) obstruction. Among 29 patients (36%) who underwent TMVR, the 30-day mortality rate was 17%. Five patients experienced LVOT obstruction, 4 of whom were predicted by CCT. Following TMVR, 5 patients had at least moderate peri-valvular regurgitation. Conclusions A minority of patients referred for TMVR planning ultimately undergo the procedure. CCT identifies unsuitable anatomy and leads to exclusion in a significant number of cases.

Purpose The purpose of this project was to design, develop, implement, and manage a sustainable process for pediatric preoperative COVD-19 testing and use the test results to determine the level of personal protective equipment and infection control required for each patient for optimal surgical scheduling and preservation of resources. Design This quality improvement project used the Plan-Do-Study-Act methodology. Multiple cycles of re-evaluation refined this process which was standardized across the enterprise. Methods A process for preoperative testing for all patients undergoing procedures requiring anesthesia was developed and implemented. Findings A safe, feasible, timely process was developed and piloted to obtain COVID-19 test results to guide individualized interventions. During the pilot, 1,707 patients were screened, and five tested positive for COVID-19, eliminating the need to manage 1702 patients as COVID-19 positive. Conclusion To continue to safely re-open, knowledge of the patient's COVID-19 status is imperative to ensure a safe journey through the perioperative area.

Background With the increasing complexity of procedures being performed in the cardiac catheterisation laboratory, the multidisciplinary team has the challenge of providing safe care to patients who present with a multitude of healthcare needs. Although the use of a surgical safety checklist has become standard practice in operating theatres worldwide, the use of a pre-procedure checklist has not been routinely adopted into interventional cardiology. Objective The aim of this study was to design and evaluate a pre-procedure checklist specific to the cardiac catheterisation laboratory. Method A descriptive, exploratory design was used to develop a specifically designed pre-procedure checklist for use in the cardiac catheterisation laboratory in a private hospital in Melbourne, Australia. The pre-procedure checklist was developed by exploring the multidisciplinary team's opinion regarding the organisation's previous surgical pre-procedure checklist through a pre-implementation survey and focus groups. Following an expert review, and implementation of the proposed pre-procedure checklist, a post-implementation survey was completed. Results Thirty-five (70%) cardiac catheterisation laboratory healthcare professionals completed the pre-implementation survey, with 31 (62%) completing the post-implementation survey. Ninety-one per cent of participants agreed that important clinical information required for interventional procedures was not documented on the previous surgical checklist. A specific checklist was developed from the results of the survey and six focus groups (N = 25) and implemented in the cardiac catheterisation laboratory. In the post-implementation survey, participants identified that the cardiac catheterisation laboratory specific pre-procedure checklist included all relevant clinical information and improved documentation of patient information. Conclusion The development of a specific cardiac catheterisation laboratory pre-procedure checklist has led to an improved transfer of pertinent clinical information required prior to procedures being performed in the unit. The outcome of this study has implications for other cardiac catheterisation laboratories with the potential to standardise practice within interventional cardiology practice and improve patient safety outcomes.

Yasushi Nakai,1 Nobumichi Tanaka,1 Toshihiko Matsubara,1 Satoshi Anai,1 Makito Miyake,1 Shunta Hori,1 Tomomi Fujii,2 Chiho Ohbayashi,2 Kiyohide Fujimoto1 1Department of Urology, Nara Medical University, Nara, Japan; 2Department of Diagnostic Pathology, Nara Medical University, Nara, JapanCorrespondence: Nobumichi TanakaDepartment of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, JapanTel +81-744-22-3051 (ext. 2338)Fax +81-744-22-9282Email sendo@naramed-u.ac.jpObjective: To evaluate factors correlated with pain during prostate biopsy and willingness to undergo transrectal ultrasound-guided prostate biopsy (TR-PBx) again without anesthesia in patients undergoing TR-PBx without anesthesia.Methods: This retrospective, single-center study evaluated 624 patients who underwent TR-PBx without anesthesia. Based on a nomogram using patient age and prostate volume, 6– 12 core biopsy samples were allocated. Anxiety was evaluated using the Faces Anxiety Scale before the TR-PBx. Pain was evaluated using the Faces Pain Scale at each puncture and immediately after confirmation of cessation of bleeding from the rectum after the transrectal probe was pulled out. The question “If this operation must be repeated, would you agree to undergo it again under same conditions?” was asked after the procedure was completed. The change in pain at each puncture and factors correlated with post-procedural pain were calculated using multiple regression analysis, and factors predicting an answer of “yes” to the question using binary logistic analysis were evaluated.Results: Scores on the Faces Pain Scale significantly increased from the first core sample to last as the number of samples increased. However, the number of samples did not show significant correlation with pain evaluated after the procedure was complete. Time during the biopsy and the anxiety score had a significant correlation with the pain scale score for the completed procedure. Short duration of TR-biopsy and a low anxiety score predicted a reply of “Yes” to the question.Conclusion: A long operative time during the TR-PBx procedure and strong pre-procedure anxiety can increase pain for patients undergoing the procedure without anesthesia and cause patients to be unwilling to undergo TR-PBx again without anesthesia.Keywords: anesthesia, anxiety, biopsy, pain, prostate cancer

Objectives: Iliac vein stenting is a relatively new procedure in the treatment of chronic venous insufficiency. Research has shown that it is a safe and effective form of treatment, however, one of the well-known risks is in-stent thrombosis. We hypothesize that a single 75 mg dose of Clopidogrel the night prior to the procedures along with a 3-month regimen post-op would decrease the 30-day thrombosis rate. Methods: A retrospective study was performed on 3,518 patients from September 2012 to August 2018 who received an iliofemoral stent. Patients were broken down into 2 main groups: those given Clopidogrel post-stent and those given Clopidogrel both pre- and post-stent. In our practice, we prescribe a 3-month course of Clopidogrel after iliac vein stenting. Patients were also checked for any anticoagulant medications pre- and/or post-stent. The 30-day thrombosis rates were recorded for each patient. Results: 1,205 patients received Clopidogrel pre-procedurally and post-procedurally, 1,941 patients received Clopidogrel only post-procedurally. 372 patients were excluded from the study because they were on other anti-coagulant medications. Mean follow-up for this cohort was 17 months. 112 total patients developed some degree of 30 day in-stent thrombosis (3.6%). 74 patients developed a complete thrombosis of the stent and 38 developed a partial (≤60% occlusion) thrombosis. Of the 1,205 patients who were on clopidogrel pre-stenting, 28 had a complete thrombosis and 10 had a partial in-stent thrombosis. Of the 1,941 patients on Clopidogrel only post-stenting, 46 had a complete thrombosis and 28 had a partial in-stent thrombosis. Using the Chi-squared test, there were no statistically significant differences between the group of patients receiving Clopidogrel pre- and post-stent vs. just post-stent with respect to 30-day any degree of thrombosis rates (complete and partial thrombosis) (p = .33). Using the Chi-squared test, there were no statistically significant differences between the group of patients receiving Clopidogrel pre- and post-stent vs. just post-stent with respect to 30-day complete thrombosis rates (p = .93). Conclusions: There appears to be no statistical difference in 30-day thrombosis rates between those receiving Clopidogrel the night prior vs. those who do not receive Clopidogrel the night prior. Therefore, we conclude that it is not necessary to give this single dose the night prior to iliac vein stenting procedures.

Recently, antegrade dissection re-entry (ADR) with re-entry device for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has evolved to become one of the pillar techniques of the hybrid algorithm. Although the success rate of the device is high, it could be improved. We sought to evaluate the current trends and issues associated with ADR in Japan and evaluate the potential of cardiac computed tomography angiography (CCTA) for ADR procedure. A total 48 patients with CTO suitable for ADR evaluated by baseline conventional angiography and CCTA were enrolled. Procedural success and technical success were evaluated as the primary and secondary observations. Furthermore, all puncture points were analyzed by CCTA. CT score at each punctured site depended on the location of plaque deposition (none; + 0, at isolated myocardial site; + 1, at epicardial site; + 2) and the presence of calcification (none; + 0, presence; + 1) was analyzed and calculated (score 0–3). Overall procedure success rate was 95.8%. Thirty-two cases were attempted with the ADR procedure and 25 cases of them were successful. The technical success rate was 78.1% and myocardial infarction or other major complications were not observed in any cases. CT score at 60 puncture sites in 32 cases were analyzed and the score at technical success points was significantly smaller compared to that at technical failure points (0.68 ± 1.09 vs 1.77 ± 1.09, p

Background And Aims: Epidural anaesthesia is widely performed using a landmark-guided midline approach. The indistinct or distorted landmark is associated with obesity, previous spinal surgeries, deformities, or degenerative changes due to ageing. In the present study, we compared the efcacy of real-time ultrasound (RUS)-guided paramedian approach, and pre-procedure ultrasound (PUS) landmark-guided paramedian approach in obese patients. Methods: Sixty patients with body mass index (BMI) >30 kg/m2 were included in the study. The participants were randomly assigned to two groups : PUS and RUS group . The primary end point was to attain a successful placement of epidural catheter. Variables like the number of attempts, the number of passes, the time taken for identifying epidural space(s), and time taken for successful epidural catheter placement(s) were secondary end points and were recorded in both the groups. Results: The median number of attempts were 4 (IQR 2-4) and 2 (IQR 1-2), respectively, in the PUS and RUS group (P-value < 0.001). The median number of passes, the median time for identifying space, and the time for successful epidural catheter placement was statistically signicantly less in the RUS group, than the PUS group. Conclusion:The time taken for the identication of the space, the number of attempts, number of passes, and the time taken for successful epidural catheter placement was more in the PUS group as compared to the RUS group.

OBJECTIVES: Sedation for upper gastrointestinal endoscopy, commonly used for diagnosis and treatment of gastrointestinal diseases, has been increasing widespread. Sedative agent requirements during sedation or anesthesia can be affected by many factors such as age and sex. In the present study, we aimed to evaluate the effects of pre-procedural anxiety levels on sedative requirements during upper gastrointestinal endoscopy. MATERIAL AND METHODS: 300 patients between the ages of 18-70 years were studied. Baseline anxiety levels were measured before the procedure using Spielberger’s State-Trait Anxiety Inventory (STAI) form X1. Propofol was administered to have BIS values between 65-85 during sedation. Doses of propofol, total procedure time, satisfaction of the patients and endoscopists and BIS values were recorded. RESULTS: Pre-procedural anxiety was 44 (40-48 [20-70]). We found significant correlations between pre-procedure anxiety and the usage of propofol (mg, mg/kg, mg/kg/dk) at BIS values between 65-85, [respectively, (p= 0.451, p

Minimally invasive techniques such as Image guided thermal ablation are now widely used in the treatment of tumors. Microwave ablation (MWA) is one of the newer modality of thermal ablation and has proven its safety and efficacy in the management of the tumors amenable for ablation for primary and metastatic diseases. It is used in the treatment of primary and secondary liver malignancies, primary and secondary lung malignancies, renal and adrenal tumors and bone metastases. We wanted to share our initial experience with this newer modality. In this article we will describe the mechanism and technique of MWA, comparison done with RFA, advantages and disadvantages of MWA along with pre procedure workup, post procedure follow-up and review of literature.

Background Real-time ultrasound (US) in central venous catheterization is superior to pre-procedure US. However, ensuring real-time US into routine practice is impeded by its perceived expense and difficulty. This expertise requires hand–eye coordination and learning curve. Moreover, availability of multiple US machines and probes for multiple operation theatres may not be possible even at the tertiary level care set-up. Currently, pre-procedure US and landmark methods are most widely used. We investigated both the techniques with application of skin markings in the pre-procedure group to ascertain efficacy and safety with a view to incorporate pre-procedure US in our practice. Methods In this randomized study, we investigated 66 patients. Thirty-three patients in the pre-procedure ultrasound group and 33 patients in the landmark group were included for right internal jugular vein (RIJV) cannulation. We recorded the first needle pass success rate, cannulation time and complications. Results Pre-procedure US was associated with more successful attempts, shorter cannulation times and less complications. Under pre-procedure US, 75.76% of first attempts were successful with a cannulation time of 50 (25–180) seconds. Under landmark technique, 27.27% of first attempts were successful with a cannulation time of 85 (20–200) seconds. First puncture success rates were higher in pre-procedure US than landmark technique, 66.67% vs 27.27%, respectively. Conclusion Pre-procedure US for RIJV catheterization is safer, quicker and superior to landmark technique.

Background:Cardiac catheterisations for CHD produce anxiety for patients and families. Current strategies to mitigate anxiety and explain complex anatomy include pre-procedure meetings and educational tools (cardiac diagrams, echocardiograms, imaging, and angiography). More recently, three-dimensionally printed patient-specific models can be added to the armamentarium. The purpose of this study was to evaluate the efficacy of pre-procedure meetings and of different educational tools to reduce patient and parent anxiety before a catheterisation.Methods:Prospective study of patients ≥18 and parents of patients Results:Twenty-three patients consented to participate, 16 had complete data for evaluation. Mean State-Trait Anxiety Inventory scores were abnormally elevated at baseline and decreased into the normal range after the pre-procedure meeting (39.8 versus 31, p = 0.008). Physician discussion, angiograms, and three-dimensional models were reported to be most effective at increasing understanding and reducing anxiety.Conclusion:In this pilot study, we have found that pre-catheterisation meetings produce a measurable decrease in patient and family anxiety before a procedure. Discussions of the procedure, angiograms, and three-dimensionally printed cardiac models were the most effective educational tools.

Introduction: Tennis elbow is a common problem, for which current available treatments are often unsatisfactory. Biologic therapies, such as platelet rich plasma (PRP) injections, aimed at stimulating healing of degenerative tendons by releasing growth factors, have shown promise in vitro study but clinical research is limited. The objective of present study is to study the efficacy of platelet rich plasma in tennis elbow, and to evaluate the outcomes of this recent modality of treatment for tennis elbow by MRI studies.Materials and Methods: Patients who were diagnosed with tennis elbow and undergone conservative treatment for at least 3 months but not improved were included in the study after obtaining written informed consent. After preparation of PRP by centrifugation, the injection was given under ultrasonography (USG) guidance at the site of tendinopathy within 4 hours of preparation. The patients were evaluated by Magnetic Resonance Imaging (MRI) pre procedure and post procedure at 1 week, 1, 2, 3, and 6 months. Result: 30 patients fulfilling the inclusion criteria were included in the study and treated with PRP. Majority of them showed significant improvement in terms MRI studies and were able to return to work at 6 months of follow up. Conclusion: Platelet-rich plasma (PRP) may represent a therapeutic option for tennis elbow. Thus, future research should focus on identifying proper treatment time, optimal dosage and ideal PRP concentration.

Purpose With the emergence of the coronavirus disease-2019 (COVID-19) pandemic, institutions were tasked with developing individualized pre-procedural testing strategies that allowed for re-initiation of elective procedures within national and state guidelines. This report describes the experience of a single US children’s hospital (Children’s Wisconsin, CW) in developing a universal pre-procedural COVID-19 testing protocol and reports early outcomes. Methods The CW pre-procedural COVID-19 response began with the creation of a multi-disciplinary taskforce that sought to develop a strategy for universal pre-procedural COVID-19 testing which (1) maximized patient safety, (2) prevented in-hospital viral transmission, (3) conserved resources, and (4) allowed for resumption of procedural care within institutional capacity. Results Of 11,209 general anesthetics performed at CW from March 16, 2020 to October 31, 2020, 11,150 patients (99.5%) underwent pre-procedural COVID-19 testing. Overall, 1.4% of pre-procedural patients tested positive for COVID-19. By June 2020, CW was operating at near-normal procedural volume and there were no documented cases of in-hospital viral transmission. Only 0.5% of procedures were performed under augmented COVID-19 precautions (negative pressure environment and highest-level personal protective equipment). Conclusion CW successfully developed a multi-disciplinary pre-procedural COVID-19 testing protocol that enabled resumption of near-normal procedural volume within three months while limiting in-hospital viral transmission and resource use.

Introduction Scientific societies recommend screening for SARS-CoV-2 in patients prior to endoscopy. There is no solid evidence regarding the efficiency of universal screening by PCR test for SARS-CoV-2. The present study aimed to assess the usefulness of clinical screening and universal pre-procedure PCR testing for the identification of patients capable of transmitting the SARS-CoV-2 infection. Concordance between both strategies was also evaluated. Method A retrospective review was conducted in a consecutive cohort of patients undergoing endoscopy at a tertiary teaching hospital between 22nd April and 22nd June 2020, following a screening protocol. Results Three hundred and sixty-one patients were included. Clinical screening detected 13 patients with a high risk of infection (3.6%, 95% CI 2.62-4.58) while the pre-procedure PCR test was positive in five patients (1.40% 95% CI 0.20-2.60). Three patients developed COVID-19 and one died from the disease. Agreement between both strategies was poor, with a Kappa value of 0.093 (95% CI 0.001-0.185). Clinical screening only identified one of the five patients with a positive PCR test. Conclusion Clinical screening prior to endoscopy presents poor agreement with the pre-procedure PCR test.

Background: Neuraxial placement relies on palpation of anatomical landmarks, sometimes challenging to identify. Ultrasound (US) has helped facilitate those procedure. We wanted to assess efficacy of the US compared to landmark techniques when used by experienced obstetric anesthesiologists. Methods: We conducted a randomized prospective trial of healthy parturients requesting neuraxial labor analgesia. Positive CSF through the 27 G Pencan spinal needle at the first interspace attempted was the primary outcome. Secondary outcomes were the number of attempts and the number of needle adjustments within a space, presence of symmetrical analgesia 2 hours after placement, and need for epidural replacement. The procedures were performed by practitioners experienced in obstetric anesthesia, including obstetric anesthesiology fellows, and attending physicians who received a video training of the US technique prior to the study [1]. Results: Forty-eight patients were randomized to either the US or landmark group. Two patients (one in each group) were excluded from the study due to delivery within 2 hours of CSE (Combined Spinal Epidural) placement. One patient in the landmark group was excluded due to a wet tap. No statistical difference was found regarding positive CSF flow on first attempt at CSE (p = 0.6). All secondary outcomes were statistically insignificant as well: number of spaces attempted (p = 0.71 95% CI –0.30 to 0.21), number of needle adjustments (p = 0.09, 95% CI –0.10 to 1.28), presence of symmetrical anesthesia at 2 hours (p = 1) and need for epidural replacement (p = 0.48). Conclusions: When placed by an experienced obstetric anesthesiology fellow or attending physician, there is no difference in the successful placement of CSE with US versus landmark technique. Key Points Summary Question: Does the use of an US machine (GE Logiq®) by experienced obstetric anesthesiology providers increase the success of neuraxial placement compared to the ‘traditional’ landmark technique. Findings: Our results did not show any statistical difference between the US and the landmark techniques when done by skilled anesthesiologists in term of the number of interspaces attempted, number of adjustments or redirections of the needle in the same interspace, the presence/absence of CSF flow upon dural puncture or the adequacy of the block 2 hours after placement. Meaning: We concluded that the use of US does not confer any benefits for neuraxial placement in this specific subgroup of practitioners.

Background: Balloon pulmonary valvuloplasty is the procedure of choice for pulmonary valve stenosis in any age group. The data on efficacy of the procedure in adolescent and adult population is scanty in Pakistan. Objective: To determine the early outcome of balloon pulmonary valvuloplasty in adolescents and adults. Study Design: Descriptive retrospective case series. Settings: Pediatric cardiology department of Faisalabad Institute of Cardiology, Faisalabad-Pakistan. Duration: Three years and Six months from 01-01-2016 to 30-06-2019. Methodology: All consecutive patients of age 10 years or above who underwent percutaneous balloon pulmonary valvuloplasty in the study period were enrolled. The outcome parameters including successfulness and complications of procedure recorded. The procedure was labelled successful if peak to peak pressure gradient across pulmonary valve reduced to less than 50% or more of the pre procedure value, suboptimal if gradient reduced by 25-49% and unsuccessful if gradient reduced by less than 25%. Results: A total of 41 patients underwent balloon pulmonary valvuloplasty procedure. Mean age was 22.2± 10.5 years while female to male ratio was 1.05:1. Majority of the patients (n=26, 63.4%) were symptomatic and dyspnea on exertion was the dominant symptom (n=16, 39%). Majority of the patients had doming pulmonary valve (n=37, 90.2%). Mean balloon to pulmonary valve annulus ratio was 1.24 ± 0.1 (range 1.1-1.43). The procedure was successful in all patients (n=41, 100%) as the mean peak to peak pressure gradient across pulmonary valve decreased from 121.9 ± 53.2 mmHg (pre valvuloplasty) to 30.1±11.9 mmHg (post valvuloplasty) irrespective of doming or dysplastic valve. There were no major complications. Transient self-limiting vaso-vagal syncope was noted in 7.3% of patients (n=3). On post procedure echocardiography there was not a single case of moderate or severe pulmonary valve regurgitation (PR) while mild PR was observed in 48.8% patients (n=20). Conclusion: Balloon pulmonary valvuloplasty in adolescent and adult patients is a very safe procedure with high success but very low complications rate.

BACKGROUND The brachial plexus is a network of nerves exiting the spinal cord through the fifth, sixth, seventh, and eighth cervical nerves (C5-C8) as well as the first thoracic nerve (T1) to conduct signals for motion and sensation throughout the arm. Brachial plexus birth injuries (BPBI) occur in 1.5 per 1,000 live births. The purpose of this study was to determine the perceived change in musculoskeletal health-related quality of life of brachial plexus patients utilizing the Pediatric Outcomes Data Collection Instrument (PODCI). PODCI scores were examined along with the patient's procedure history (surgical or Botulinum Toxin), extent of involvement and demographics. PATIENTS A total of 81 patients from two to eighteen years of age from nine different states met the inclusion criteria of having a pre-procedure and post-procedure PODCI score along with a Narakas score from 2002-2017. These patients were seen at the Brachial Plexus Center, which is an interdisciplinary clinic at a large academic medical centerMETHODS: This retrospective study utilized PODCI data collected annually during their regular brachial plexus clinic visits. Upper extremity (UE) and global functioning (GFx) scores pre- and post-procedure were stratified by Narakas Classification. Data were analyzed using paired t-test and ANOVA testing. RESULTS Patients with a Brachial Plexus Birth Injury (BPBI) had lower PODCI scores for UE and GFx when compared with the pediatric normative scores for age-matched healthy children. Scores in both UE and GFx domains were higher after procedure in the groups of Narakas I and IV. There was significant correlation between UE and GFx scores and documented first PODCI score (2 years of age) and age at intervention (5 years of age). CONCLUSION Procedures increased the perceived quality of life for children with a BPBI and increased their overall PODCI scores for both UE and GFx.

Background Antimicrobial prophylaxis is an evidence-proven strategy for reducing procedure-related infections; however, measuring this key quality metric typically requires manual review, due to the way antimicrobial prophylaxis is documented in the electronic medical record (EMR). Our objective was to electronically measure compliance with antimicrobial prophylaxis using both structured and unstructured data from the Veterans Health Administration (VA) EMR. We developed this methodology for cardiac device implantation procedures. Methods With clinician input and review of clinical guidelines, we developed a list of antimicrobial names recommended for the prevention of cardiac device infection. We trained the algorithm using existing fiscal year (FY) 2008–15 data from the VA Clinical Assessment Reporting and Tracking-Electrophysiology (CART-EP), which contains manually determined information about antimicrobial prophylaxis. We merged CART-EP data with EMR data and programmed statistical software to flag an antimicrobial orders or drug fills from structured data fields in the EMR and hits on text string searches of antimicrobial names documented in clinician’s notes. We iteratively tested combinations of these data elements to optimize an algorithm to accurately classify antimicrobial use. The final algorithm was validated in a national cohort of VA cardiac device procedures from FY2016–2017. Discordant cases underwent expert manual review to identify reasons for algorithm misclassification. Results The CART-EP dataset included 2102 procedures at 38 VA facilities with manually identified antimicrobial prophylaxis in 2056 cases (97.8%). The final algorithm combining structured EMR fields and text note search results correctly classified 2048 of the CART-EP cases (97.4%). In the validation sample, the algorithm measured compliance with antimicrobial prophylaxis in 16,606 of 18,903 cardiac device procedures (87.8%). Misclassification was due to EMR documentation issues, such as antimicrobial prophylaxis documented only in hand-written clinician notes in a format that cannot be electronically searched. Conclusions We developed a methodology with high accuracy to measure guideline concordant use of antimicrobial prophylaxis before cardiac device procedures using data fields present in modern EMRs. This method can replace manual review in quality measurement in the VA and other healthcare systems with EMRs; further, this method could be adapted to measure compliance in other procedural areas where antimicrobial prophylaxis is recommended.

Introduction: Dimethicone enhances diagnostic accuracy in Oesophagogastroduodenoscopy (EGD). Various regimens have been tried to ease the procedure for better mucosal visibility. Aim: To evaluate the efficacy of activated dimethicone in improving endoscopic visibility. Materials and Methods: The present prospective study was carried out from February 2017 to February 2018 in a tertiary teaching hospital, Chennai, India. A total of 2917 patients aged 18-70 years were enrolled for this study. The participants were divided into group S (1540 patients) and group C (1377 patients). Group S received activated dimethicone 30 minutes before the procedure and group C underwent procedure without any pre-procedure preparation. The mucosal visibility score was evaluated in both the groups. Statistical analysis was conducted using IBM SPSS statistics (version 23.0). Unpaired student’s t-test and Pearson Chi-Square test are used for statistical analysis of the data and in both, p

Objective To evaluate the effect of a pre-procedural information video on anxiety levels in patients undergoing hysterosalpingography (HSG). Material and methods Among a total of 131 primary or secondary infertile patients, 66 were shown an information video and 67 control patients received standard care between August 2014 and January 2016. The video included information on the procedure, personnel, and the room for the procedure; the video was shown on the morning of the procedure. Patients were randomized using the complete randomization technique through which patients were included in the study and control groups week by week, randomly. The Beck Anxiety Inventory scale was conducted to the patients one hour before the procedure. Results There were no differences in demographic data. The history of previous gynecologic operations was higher in the control group. The Beck Anxiety score was significantly lower in the study group compared with the control group (6 vs 10). Conclusion Our findings suggest that as an easy intervention to implement, a pre-procedural video education may be a beneficial tool for the management of HSG-related anxiety.

The World Health Organization (WHO) introduced surgical safety checklist (SSC) as a part of Second Global Patient Safety Challenge: Safe Surgery Saves Lives to address the safety of surgical care. Althoughfound to be benefi cial for general surgical patient, we introduced certain modification to suit neurosurgical patients and hereby present our experience with the modified checklist.We introduced the modified SSC in July 2012 for neurosurgical purpose after we identified minor but common errors in carefully audited 100 patients in our operating theatre. Modification included checklists in pre procedure room, during sign in enquiring for pulse oximeter (for local anesthetic procedures) and lastly during sign out an elaborated list of items to guarantee safe transfer of the patients. Nurses and doctors were trained and SSC was methodically administered.Outcome as number of complications was evaluated and graded according to no harm, low harm, moderated harm, severe harm and death. During last 5 years (July 2012 to June 2017), 1310 patients undergoing surgical procedures in neurosurgical theatre at KMCTH were studied. Modified SSC was used in both routine (50.5%) and emergency cases (49.5%), of which compliance was 80% and 55% respectively. Poor compliance was due to ignorance of its use, emergency nature of procedure, change of staff. Completeness of mSSC was found in 70% cases with most left out part of mSSC was during signing out (i.e during transfer of patients). Use of mSSC identified many common but minor negligent acts on part of doctors, nurses and OR technicians which could be rectified in time and hence avoided any major mishaps. Age of the patients ranged from newborn to 98 year old. There were no major mishaps including death on table events. Despite confirming during mSSC checklist, machine failure occurred in 10 cases (0.8%) which were of low harm category. The total time taken for performing and filling the checklist took roughly 7 minutes.We modified WHO surgical safety checklist to include post operative transfer out to recovery room and used it in both routine and emergency procedures. This has helped us to avoid major mishaps during and after the neurosurgical procedures. We recommend stringent use of SSC in all neurosurgical centre and advise suitable local modifications according to prevailing conditions for special procedures or locations.Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page: 7-12

Background and aims: With the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, healthcare providers abruptly changed their delivery of care to protect patients and staff from infection. One such change was to convert in-person advanced gastrointestinal endoscopy pre-procedure consultations to telemedicine visits. The use of telemedicine has been successfully used in the field of gastroenterology in managing symptoms and chronic conditions among established patients. However, to our knowledge, there is little literature on the utility of this modality for pre-procedure consultation visits, where patients often meet their proceduralists for the first time. The aim of this study was to compare overall patient satisfaction among those who had pre-procedure consultation visits by telemedicine, in –person, or a direct access procedure (instructions and procedure explained by a nurse practitioner or physicians assistant). Methods: Patients who had undergone an advanced endoscopic procedure at Long Island Jewish Hospital from the months of May 2020 to August 2020 were called by telephone and asked to complete a modified version of the validated patient satisfaction survey mGHAA-9. The survey was designed to assess patient satisfaction in their pre-procedure, intra-procedure, and post procedure experiences. Patients were grouped based on whether they had received an in-clinic consultation visit by the endoscopist, telemedicine consultation visit by the endoscopist, or direct access. Geographic location to the office, prior endoscopic experience, type of endoscopic procedure (diagnostic vs. therapeutic), and new gastrointestinal cancer diagnosis data were recorded. Results: Of the total 322 patients that were called, 123 agreed to participate (38%) and provided responses to the survey. There were 26 who had in person consultation visits, 32 who had telemedicine consultation visits, and 65 direct access visits. Overall mean satisfaction among the three groups did not reveal a statistically significant difference (p value= 0.983). Furthermore, sub-analysis of the preprocedure, intra procedure, and post procedure satisfaction scores did not reveal statistically significant differences (p=0.996, p=0.244, and p=0.998, respectively). However, patients with a new gastrointestinal cancer diagnosis had a statistically significant higher mean satisfaction score in those who had telemedicine visits with proceduralists compared to those who had direct access procedures (P=0.0116). Conclusion: Our study suggests that pre-procedure consultation visits by telemedicine, in-person, or direct access all have similar satisfaction scores among patients. However, telemedicine consultation visits with the endoscopist may be preferred over direct access in patients who have a clinically high suspicion for a new gastrointestinal cancer diagnosis. [Formula presented]

Background and Aims Elective endoscopy resumed in our outpatient ambulatory center after instituting the preprocedure policy of a confirmed negative coronavirus disease 2019 (COVID-19) reverse transcriptase polymerase chain reaction (RT-PCR) status performed 72 hours before a scheduled procedure as mandated by the state of Illinois. In addition, all patients were required to contemporaneously complete the American Society for Gastrointestinal Endoscopy (ASGE) COVID-19 risk screening questionnaire published April 28, 2020 as outlined in the ASGE guidance document for reopening GI endoscopy during the COVID-19 pandemic. The aim of our study is to report the outcomes of 1000 patients who successfully completed the clinical aspects of the ASGE COVID-19 risk screening questionnaire and whose RT-PCR tests were valid for interpretation. Methods Data were retrospectively collected from patient medical records for demographics, symptom responses to the preprocedure ASGE COVID-19 risk screening questionnaire, and RT-PCR test results of patients scheduled to undergo an elective outpatient endoscopy at Rockford Gastroenterology Associates from May 22 through June 28, 2020. Descriptive statistics and standard calculation methods to determine both positive and negative predictive values were used for data analysis. Results Eight of 1000 patients included in the study tested positive for COVID-19. Three of 8 patients reported 1 or more symptoms on the ASGE COVID-19 risk screening questionnaire. One hundred nineteen additional patients reported symptoms on the ASGE COVID-19 risk screening questionnaire but tested negative for COVID-19. The positive and negative predictive values of the ASGE COVID-19 risk screening questionnaire were 2.46% and 99.43%, respectively. Conclusions The low incidence of COVID-19 infection in a community-based ambulatory surgery center is supported by a positive RT-PCR test rate of .80%. Absence of symptoms on the ASGE COVID-19 risk screening questionnaire was highly predictive of a negative RT - PCR test (99.43% negative predictive value), whereas the positive predictive value was low (2.46%) in symptomatic patients. A positive RT-PCR test was invaluable in preventing 5 asymptomatic patients from undergoing endoscopy. Similarly, 119 symptomatic patients underwent endoscopic evaluation who would have otherwise been excluded without RT-PCR testing. Symptom-based screening alone should not be the primary preprocedural assessment tool in selecting patients for undergoing endoscopy during the COVID-19 pandemic.

Background:clinical outcome data was analyzed for 100 patients withcontained disc herniation who underwent percutaneous discdecompression procedure using Coblation® technology,after failing to respond toconservative management. Patients and Methods: Patients presented with clinicalsymptoms of discogenic low back pain and/or leg painFollow-up data was collected up to 12 months.Patient gender distribution was 68% female, 32% male, witha mean age of 39 years.With mean duration of back pain of 8.57 ,ranging from 3 to 17 month and mean duration of leg pain of 4.36 .ranging from 2 to 10 monthaccording to visual analogue scale for pain assessment.The mean pre-procedure pain level for all patients wasReported as 7.56 for back and 7.72 for leg while average pain level was 4.86 for back and 3.42 for leg at the 12-month follow-up post procedure period. And according to Oswestry disability index for functional assessment. The mean pre procedure index was 31.48 range from 23-40. It decreased after 12 month to 13.82 range from 5-32. Results:The results of this analysis indicated that PDD usingCoblation technology, isan effective procedure for patients presenting withdiscogenic back and/or leg pain who have failed conservativetherapies.

Introduction: Tendinopathy is a repetitive strain injury caused by repetitive overuse of the muscles of the body. It causes pain and functional impairment in daily activities. The treatment of this condition includes conservative therapy and surgical interventions. The effectiveness of oral nonsteroidal anti-inflammatory agents, topical and injectable medications including corticosteroids and botulinum toxins, splinting, physical therapy, and iontophoresis has been evaluated in many studies. Platelet-rich plasma (PRP) therapy has been utilized for nearly two decades to treat degenerative joint disease and speed recovery from soft tissue injuries to tendons, muscles and ligaments. Aim: The present study aims at evaluating the results of PRP treatment in chronic tendinopathy and assessment of joint function and functional abilities of patients in follow up studies. Materials and Methods: This study was a prospective, comparative, single blind study, carried out in 30 patient. The patients were assessed pre procedure and post procedure in form of range of movements, pain, tenderness, joint stiffness and early mobilization. Quantity of PRP given was 2 ml in 6 month chronicity. The functional outcome of PRP treatment was evaluated with visual analogue score. Results and Discussion: The functional outcome i.e. pain improvement in our study was evaluated using VAS (Visual analogue Score). About 64% patients in our study attained excellent VAS scores. Our results were comparable to the results obtained by Mishra and his colleagues8, in 2006, where patients who had received PRP treatment showed 60% improvement in their VAAS pain score. Conclusion: Our study had shown good to excellent symptom improvement in 90% of patient. Almost all patient treated with PRP had good range of motion and pain relief at the end of the study and most of patients were able to do their routine or previous work and activities without any difficulty. Being newer techniques, PRP treatment requires further evaluation and there is a steep learning curve

To evaluate the value of pre-radiofrequency ablation (RFA) MR and post-RFA CT registration for the assessment of the therapeutic response of hepatocellular carcinoma (HCC).A total of 178 patients with single HCC who received RFA as an initial treatment and had available pre-RFA MR and post-RFA CT images were included in this retrospective study. Two independent readers (one experienced radiologist, one inexperienced radiologist) scored the ablative margin (AM) of treated tumors on a four-point scale (1, residual tumor; 2, incomplete AM; 3, borderline AM; 4, sufficient AM), in two separate sessions: (1) visual comparison between pre-and post-RFA images; (2) with addition of nonrigid registration for pre- and post-RFA images. Local tumor progression (LTP) rates between low-risk (response score, 3-4) and high-risk groups (1-2) were analyzed using the Kaplan-Meier method at each interpretation session.The patients' reassignments after using the registered images were statistically significant for inexperienced reader (p 0.001). In the inexperienced reader, LTP rates of low- and high-risk groups were significantly different with addition of registered images (session 2) (p 0.001), but not significantly different in session 1 (p = 0.101). However, in the experienced reader, LTP rates of low- and high-risk groups were significantly different in both interpretation sessions (p 0.001). Using the registered images, the cumulative incidence of LTP at 2 years was 3.0-6.6%, for the low-risk group, and 18.6-27.8% for the high-risk group.Registration between pre-RFA MR and post-RFA CT images may allow better assessment of the therapeutic response of HCC after RFA, especially for inexperienced radiologists, helping in the risk stratification for LTP.