Let the EHR Talk Loudly: An EHR-Connected Verbal Surgical Safety Checklist for Medical Procedures in the Intensive Care Unit.

OBJECTIVES: The purpose of this study was to test the accuracy and user acceptance of an electronic health records (EHR)-connected verbal surgical safety checklist in the intensive care unit (ICU). METHODS: An EHR-connected verbal checklist software was deployed in our ICU between January 2019 and June 2019. The software, loaded on a mobile tablet, loudly verbalized clinical information from the EHR in the form of a time-out checklist. The accuracy of the information delivered was compared with up-to-date clinical data in the EHR in 300 patients. User acceptance was assessed using survey instruments. RESULTS: The software accurately verbalized patient demographics in 100% (300/300) of tested cases. Concordance rates with real-time values in the EHR for the following variables were calculated: allergies 98.6% (296/300), international normalized ratio 97.6% (293/300), and platelets 91.6% (275/300). Surveys showed that 41.2% (7/17) of users preferred current standard EHR time-outs, 17.6% (3/17) preferred verbalization software, 35.3% (6/17) preferred neither, and 5.9% (1/17) wanted both. When asked if EHR-connected verbalization software should officially replace the current standard EHR checklists, 76.5% (13/17) supported the idea. CONCLUSIONS: An EHR-connected verbal surgical safety checklist software can leverage information in the EHR to help with workflow and patient safety. This study shows that the software can verbally deliver clinical information with great accuracy and that most ICU staff would support replacing current time-out processes.

Role of imaging in the diagnosis of vascular malformations vascular malformations.

Imaging evaluation of vascular malformations (VM) is paramount for proper diagnosis and treatment planning. These lesions often present as complex vascular masses with arterial, venous and lymphatic components, requiring the use of advanced imaging modalities for full anatomical characterization. Symptoms also depend of the location and flow characteristic of such lesions and range from: asymptomatic to severe forms of cardiac arteriovenous shunting. We present an overview of the diagnostic work-up of VM per most recent classification systems and describe imaging characteristics of such lesions at ultrasonography (US) and magnetic resonance imaging (MRI) as a diagnostic tool for work-up of such patients.

Comparison of clinical outcome between pyeloperfused versus non-pyeloperfused microwave ablation of renal cell carcinoma.

PURPOSE: We present the outcomes of microwave ablation (MWA) of renal cell carcinoma (RCC) with and without pyeloperfusion. MATERIAL AND METHODS: A retrospective review of patients' records was undertaken to identify patients with RCC, who were treated with MWA with and without adjunctive pyeloperfusion. The distance between the tumour and ureter as well as the tumour size were measured on axial imaging. Pyeloperfusion was performed in nine patients in this series after placement of a ureteral stent and instilment of diluted contrast into the ureter. MWAs of the tumours were performed under computed tomography (CT) guidance. Hydrodissection was performed to displace at-risk organs. Creatinine was measured as renal function index after and before the procedure. A CT scan was performed at the end of the procedure and also after one, three, and six months, to identify the presence of residual disease and complications. RESULTS: Eighteen biopsies of proven RCC were treated with 20 sessions of MWA. The average follow-up time for this study was 180 days. The average distance between the ureter and the tumour in axial CT view was 20.8 (± 2.9) mm. Primary efficacy was achieved in 88% of pyeloperfused patients and in 100% of the non-pyeloperfused patients. Two pyeloperfused patients required secondary procedure, and full secondary efficacy was achieved for both. There was only one grade 2 urological complication, which occurred in a patient who underwent pyeloperfusion. Creatinine was not significantly different after the procedure in this study (p-value 0.4). CONCLUSION: In this study MWAs of RCCs were successfully performed using pyeloperfusion as a protective measure against thermal injury to the ureter.

Ureteral protection during microwave ablation of renal cell carcinoma: combined use of pyeloperfusion and hydrodissection.

A 56-year-old female with past medical history of thrombotic microangiopathy presented to her physician with nonspecific abdominal pain. A magnetic resonance imaging scan was obtained, which revealed a 3.1 cm mass arising from medial lower pole of the left kidney that was subsequently shown to be renal cell carcinoma by percutaneous biopsy. Because of her history of thrombotic microangiopathy and other comorbidities, she was deemed a nonsurgical candidate and was therefore referred to interventional radiology for thermal ablation. Computed tomography (CT)-guided microwave ablation was performed with the combined use of pyeloperfusion and hydrodissection for maximal ureteral protection. Follow-up unenhanced CT scan obtained one month after ablation showed a normal collecting system without evidence of hydronephrosis or urinoma.

Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Pleural Effusion.

BACKGROUND: One of the most common indications for pleuroscopy is undiagnosed pleural effusion, which comprises about 25% of all cases of pleural effusions, which remain undiagnosed despite primary tests. Pleuroscopy was performed for the first time in Iran in Masih Daneshvari hospital located in Tehran. The aim of this study was to assess the diagnostic yield of pleuroscopy performed in this center in Iran. MATERIALS AND METHODS: Three-hundred patients with undiagnosed pleural effusions were enrolled in this study. For all patients, primary tests including pleural effusion analysis, cytology and closed pleural biopsy (if needed) were conducted and all of them were inconclusive. The semirigid thoracoscopy (pleuroscopy) was performed for all patients for diagnostic purposes. RESULTS: Eighty-seven percent of the peluroscopies were diagnostic and 67% of them were diagnosed as malignancy while the rest were diagnosed as tuberculosis. Only 11 patients developed minor complications. CONCLUSION: In conclusion, pleuroscopy is a safe procedure when performed by a skilled and experienced practitioner; it has a high diagnostic yield and results in only minor complications.

Association of urinary lipocalin-2 with lupus nephritis.

OBJECTIVE(S): Lupus nephritis (LN) is the main cause of mortality and disability in systemic lupus erythematosus (SLE) patients. Therefore, utilizing a reliable and non-invasive method for serial measurements of renal function seems to be necessary. The aim of this study was to evaluate the role of urinary lipocalin-2 as a biomarker of renal involvement in SLE patients. MATERIALS AND METHODS: Fifty two lupus patients in this cross sectional study were divided into two groups: patients with and without nephritis. For each group, urinary lipocalin-2, values were measured and reported according to urinary lipocalin-2/creatinine. Urinary lipocalin-2/creatinine sensitivity and specificity for identifying biopsy-proven nephritis were calculated, and a receiver operating characteristic (ROC) curve was constructed. Results : The mean urinary lipocalin-2/creatinine value of patients with biopsy-proven LN was 2.99 ± 4.1 ng/mg, and in non-LN patients was 1.16 ± 1.27 ng/mg. Urinary lipocalin-2/creatinine levels in LN patients were significantly higher than those in non-LN patients (P- Value = 0.03). In LN patients, urinary lipocalin-2/creatinine significantly correlated with proteinuria (r = 0.68; P = 0.0001). Using a cutoff value of 0.896 ng/mg, urinary lipocalin-2/creatinine had a sensitivity of 89.7% and a specificity of 39.1% for identifying SLE patients with biopsy-proven LN. The area under the ROC curve was 0.664 ± 0.076 with a 95% confidence interval of 0.52-0.81 (P=0.04). Analysis of variance showed that urinary lipocalin-2/creatinine is the same in different classes of LN (P-value=0.28). CONCLUSION: An important clinical conclusion is that measurement of urinary Lipocalin-2 may result in earlier diagnosis of LN.