Use of Accessible Weight Scales and Examination Tables/Chairs for Patients with Significant Mobility Limitations by Physicians Nationwide.

BACKGROUND: Mobility limitations are the most common disability type among the 61 million Americans with disability. Studies of patients with mobility limitations suggest that inaccessible medical diagnostic equipment poses significant barriers to care. METHODS: The study team surveyed randomly selected US physicians nationwide representing seven specialties about their reported use of accessible weight scales and exam tables/chairs when caring for patients with mobility limitations. A descriptive analysis of responses was performed, and multivariable logistic regression was used to examine associations between accessible equipment and participants' characteristics. RESULTS: The 714 participants (survey response rate = 61.0%) were primarily male, White, and urban, and had practiced for 20 or more years. Among those reporting routinely recording patients' weights (n = 399), only 22.6% (standard error [SE] = 2.2) reported always or usually using accessible weight scales for patients with significant mobility limitations. To determine weights of patients with mobility limitations, 8.1% always, 24.3% usually, and 40.0% sometimes asked patients. Physicians practicing ≥ 20 years were much less likely than other physicians to use accessible weight scales: odds ratio (OR) = 0.51 (95% confidence interval [CI] = 0.26-0.99). Among participants seeing patients with significant mobility limitations (n = 584), only 40.3% (SE = 2.2) always or usually used accessible exam tables or chairs. Specialists were much more likely than primary care physicians to use accessible exam tables/chairs: OR = 1.96 (95% CI = 1.29-2.99). CONCLUSION: More than 30 years after enactment of the Americans with Disabilities Act, most physicians surveyed do not use accessible equipment for routine care of patients with chronic significant mobility limitations.

Evaluating Canadian Radiation Therapists and UK Therapeutic Radiographers' Experiences and Opinions of a Safety Strap to Secure Patients during Radiotherapy.

INTRODUCTION: A serious patient safety incident at a cancer centre in Ontario, Canada, saw a patient fall from an elevated treatment couch. A regional investigation recommended the use of a securing safety strap. The authors evaluate the value of the strap through the experiences of the radiation therapists' who use it. A secondary aim is to explore the potential for using a securing safety strap with UK therapeutic radiographers. METHODS: A two-stage design was guided by an evidence-based practice framework. Stage one used a questionnaire to capture treating radiation therapists' experiences and opinions of the strap at a single cancer centre. Quantitative data were analysed descriptively and free-text data via a content analysis. Stage two used semistructured interviews with thematic analysis to explore views of three UK therapeutic radiographers. RESULTS: Twenty-five of approximately 130 eligible staff responded to the Canadian questionnaire. Of the respondents, 24% (n = 6) 'strongly disagreed', 28% (n = 7) 'agreed' and 48% (n = 12) 'neither agreed nor disagreed' that they would recommend the strap to other departments. Most of the respondents think strap use should be at the staffs' discretion, with patients with dementia/cognitive impairment ranked as the group benefiting most. Ninety-two percent (n = 23) of respondents confirmed that patients sometimes refuse the strap. Themes arising from stage two interviews are as follows: patient benefit (use for select patients only); patient safety versus control (restraint); and practical implementation issues. CONCLUSION: The policy of universal use of the strap should be reviewed. Those who use it are equivocal about its value and feel it should be reserved for select patients at the treating professional's discretion. Full evaluation of the effectiveness and acceptability of the device for different patients may promote both staff enthusiasm towards the device and evidence-based practice. Adequate resources are required to evaluate implementation of such safety initiatives.

A Phantom-Based Method to Assess X-Ray Table Mattress Interface Pressures.

BACKGROUND: Pressure redistribution performance of x-ray table mattresses can influence the development of pressure ulcers in at-risk populations. Interface pressure analysis, with human participants, is a common method to assess mattresses. This approach has limitations that relate to the lack of standardisation between and within humans. AIM: This study aimed to develop and validate an anthropomorphic phantom-based method to assess x-ray table mattress interface pressures as an index of mattress performance. METHODS: A three dimensional phantom simulating an adult's head, pelvis, and heels was printed from x-ray computed tomography image data and attached to a metal frame 175 cm in length. Dry sand was added to the phantom head, pelvis, and heels to represent a range of human weights. Pressure distribution was assessed using XSensor. Phantom validation was achieved by comparing phantom mattress interface pressure characteristics, for five human equivalent weights, against 27 sets of human mattress interface pressure data. RESULTS: Using the correlation coefficient R, phantom and human pressure data showed good correlation for the five phantom weights (R values: head = 0.993, pelvis = 0.997, and heels = 0.996). CONCLUSION: A novel method to test x-ray mattresses for interface pressure was developed and validated. The method could have utility in the testing of x-ray mattresses that are in routine use and for new mattress development. Phantom interface pressure data could be provided by manufacturers to help inform procurement decisions when matching mattress characteristics to medical imaging demands and the underlying patient populations.

Exploring the Effects of Clinical Exam Room Design on Communication, Technology Interaction, and Satisfaction.

OBJECTIVE: This article evaluates the effects of technology integration and design features in clinical exam rooms on examination experiences, communication, and satisfaction. BACKGROUND: Exam room features can affect the delivery of patient-centered care and enhance the level of communication, which has been shown to directly impact clinical outcomes. Although there has been an increasing body of literature examining design and patient-centered care, little research has evaluated the extent to which information sharing and electronic health record (EHR) interaction are impacted. METHOD: The research randomly allocated 22 patients, 28 caregivers, and 59 clinicians to simulated clinical encounters in four exam room mock-ups with semi-inclusive, exclusive, and inclusive layouts (128 sessions in 32 scenarios). Video recordings of the simulations were coded for clinician gazing, talking, and EHR-interaction behaviors. Participants also completed surveys and answered open-ended questions after experiencing each scenario (N = 362). RESULTS: Semi-inclusive rooms with a triangular arrangement of consultation table, sharable screens, exam table, and caregiver chair were highly preferred as they supported conversation, gazing, and information sharing. The inclusive layout had higher durations of EHR interactions and enhanced viewing and sharing of EHR information. However, this layout was criticized for the lack of clinician-shared information. The exclusive layouts impeded information sharing, eye contact, and constrained simultaneous data entry and eye contact for clinicians. The distance and orientation between chair, exam table, curtain, and door were important for protecting patient and family comfort and privacy. CONCLUSION: Characteristics and configurations of design qualities and strategies have a key role on examination experiences, communication, and satisfaction.

Use of Accessible Examination Tables in the Primary Care Setting: A Survey of Physical Evaluations and Patient Attitudes.

BACKGROUND: Accessible diagnostic equipment, including height-adjustable examination tables, is necessary to accommodate patients with disabilities. Studies demonstrate that only a minority of clinics provide accessible equipment. For clinics with this equipment, no studies have examined the use of such equipment in routine clinical care. OBJECTIVE: In primary care clinics with and without height-adjustable examination tables, we compared the frequency and variation in physical evaluations on examination tables and patients' perceptions of quality care. DESIGN: Survey administered to patients at two primary care clinics in Rochester, MN, in 2015. One clinic had height-adjustable examination tables in every exam room; the other clinic had none. PATIENTS: A total of 399 English-speaking adult primary care patients (61% participation). MAIN MEASURES: Participants were asked whether they were physically evaluated on a table during their clinical encounter. In addition, they completed two subscales of the Patient Perception of Quality of Care survey: Perceptions of Provider's Bedside Manner and Perceptions of Provider's Work. KEY RESULTS: Overall, there were no differences between clinics in the likelihood of patients being examined on an exam table or in their perceptions of quality of care. Across both clinics, patients who reported a disability were 27% less likely to be examined on a table, were less likely to rate their provider's bedside manner favorably (74% vs. 59%) and to have positive perceptions of their provider's work (46% vs. 32%) than patients without disabilities. CONCLUSIONS: The presence of accessible medical equipment was not associated with care delivered to patients. While this might not be meaningful for most patients, it could be problematic for patients with disabilities, who are less likely to be examined. Therefore, accessible equipment alone may not be sufficient to reduce disparities in the care experience. Provider- and organization-level factors must thus be considered in efforts to provide equitable care to patients with disabilities.

Incidence of human papillomavirus contamination of transvaginal probes in Japan and possible contamination prevention strategy.

PURPOSE: To clarify the present status of human papillomavirus (HPV) contamination of transvaginal probes in Japan and propose a preventive method. METHODS: This study was performed at three institutes: a tertiary center, secondary hospital, and primary facility. To identify contamination rates, probes were disinfected and covered with probe covers and condoms; the cover was changed for each patient. The probes were tested for HPV, and those with HPV detected were analyzed to identify the type of HPV. Next, nurses put on new gloves before covering the probe for each patient, and the probes were similarly tested for HPV. RESULTS: A total of 120 probes were tested, and HPV was detected from a total of five probes, a contamination rate of 4.2 % (5/120). HPV was detected in all three institutes. Importantly, high-risk HPV, i.e., HPV-52, 56, and 59, was detected. After the "glove change strategy" was implemented, HPV was not detected on any of 150 probes tested at any of the three institutions. CONCLUSIONS: In Japan, the HPV contamination rate of vaginal probes in routine practice was 4.2 %. There was no HPV contamination of probes after changing the gloves for cover exchange for each patient. This strategy may prevent HPV probe contamination.

Reducing Occupational Risk to Ambulatory Caregivers.

In recent years, safe patient handling in the health care industry has been addressed by various stakeholders, but much work remains to reduce health care worker injuries, and improve safety and care quality for patients. Recently, safe patient handling in ambulatory care settings has gained attention. As health care delivery evolves, demands on ambulatory care will increase and more dependent patients will visit ambulatory care clinics. Typically, ambulatory care clinics are not equipped with appropriate safe patient handling equipment. Examination tables, standard in ambulatory care clinics, currently have fixed height and are not easily accessible. This study investigated the benefits of introducing new height-adjustable examination tables to an ambulatory care setting. The results of this study indicate that by using height-adjustable examination tables, work-related musculoskeletal disorder (WMSD) risk for caregivers can be significantly reduced.

[The Relation between the Height of Radiographic Table and Workloads of Radiologic Technologist in General X-ray Examinations].

Workloads of radiological technologists under different conditions of heights of radiographic table and/or X-ray tube assembly were calculated using a software for preventing musculoskeletal complaint to investigate optimal working environment for general X-ray examinations. In the patient positioning, compressive force of lumbar disc decreased at higher radiographic table within the range of 45-90 cm. On the other hand, workload of the shoulder joint increased with increase in the height of radiographic table. Load of the shoulder joint similarly increased as the height of the X-ray tube assembly increased. Compressive force of lumbar disc reduced by approximately 10-30% as the height ratio of the radiographic table to body height increased by approximately 40%, compared to the lowest table of 45 cm. Muscle load of a 50-years-old woman was approximately double compared to a 30-year-old man, even in the same workload. It is important to keep suitable height of radiographic table for reduction of the workloads of lumbar rather than shoulder joint, because floating-type radiographic table is generally used.

Accessibility of outpatient healthcare providers for wheelchair users: Pilot study.

The Americans with Disabilities Act (ADA) requires full and equal access to healthcare services and facilities, yet studies indicate individuals with mobility disabilities receive less than thorough care as a result of ADA noncompliance. The objective of our pilot study was to assess ADA compliance within a convenience sample of healthcare clinics affiliated with a statewide healthcare network. Site assessments based on the ADA Accessibility Guidelines for Buildings and Facilities were performed at 30 primary care and specialty care clinics. Clinical managers completed a questionnaire on standard practices for examining and treating patients whose primary means of mobility is a wheelchair. We found a majority of restrooms (83%) and examination rooms (93%) were noncompliant with one or more ADA requirements. Seventy percent of clinical managers reported not owning a height-adjustable examination table or wheelchair accessible weight scale. Furthermore, patients were examined in their wheelchairs (70%-87%), asked to bring someone to assist with transfers (30%), or referred elsewhere due to an inaccessible clinic (6%). These methods of accommodation are not compliant with the ADA. We recommend clinics conduct ADA self-assessments and provide training for clinical staff on the ADA and requirements for accommodating individuals with mobility disabilities.

The Influence of Patient Positioning in Breast CT on Breast Tissue Coverage and Patient Comfort.

PURPOSE: The presented study aimed at optimizing a patient table design for breast CT (BCT) systems with respect to breast tissue coverage and patient comfort. Additionally, the benefits and acceptance of an immobilization device for BCT using underpressure were evaluated. MATERIALS AND METHODS: Three different study parts were carried out. In a positioning study women were investigated on an MRI tabletop with exchangeable inserts (flat and cone-shaped with different opening diameters) to evaluate their influence on breast coverage and patient comfort in various positioning alternatives. Breast length and volume were calculated to compare positioning modalities including various opening diameters and forms. In the second study part, an underpressure system was tested for its functionality and comfort on a stereotactic biopsy table mimicking a future CT scanner table. In the last study part, this system was tested regarding breast tissue coverage. RESULTS: Best results for breast tissue coverage were shown for cone-shaped table inserts with an opening of 180 mm. Flat inserts did not provide complete coverage of breast tissue. The underpressure system showed robust function and tended to pull more breast tissue into the field of view. Patient comfort was rated good for all table inserts, with highest ratings for cone-shaped inserts. CONCLUSION: Cone-shaped tabletops appeared to be adequate for BCT systems and to allow imaging of almost the complete breast. An underpressure system proved promising for the fixation of the breast during imaging and increased coverage. Patient comfort appears to be adequate. KEY POINTS: Tissue coverage in breast CT is highly dependent on patient table design. An underpressure fixation system shows potential to increase breast coverage. The proposed breast CT patient table design combines good coverage and patient comfort.

Body packers on your examination table: How helpful are plain x-ray images? A definitive low-dose CT protocol as a diagnosis tool for body packers.

AIM: To analyze the clinical value and radiation dose of plain x-rays and CT in examining patients suspected of ingesting drug-filled packets. MATERIALS AND METHODS: Thirty-eight patients with suspected internal concealment of drug-filled packets who were examined with plain x-rays or CT or both were included in the study. CT studies were performed using low-dose and standard-dose techniques. All radiographic images were analysed by two radiologists regarding identification of the packets and estimating the effective radiation dose from standard- and low-dose CT versus conventional x-ray examinations. Descriptive calculations were made regarding the number and density of packs and radiation dosage. The diagnostic performance of both radiologists with standard- and low-dose CT was calculated by analysing differences in the mean number of packs found. RESULTS: Thirty-one patients were positively identified as body packers with an average of 13 packs (min: n = 1, max: n = 58, total: n = 390); seven patients were not concealing drug packets. X-ray images were taken of 24 patients prior to CT, thus allowing a direct comparison between the two methods. The correct diagnosis was made in 42%, in 33% the radiologists were uncertain, and in 25% of drug packets were either not or wrongly identified. X-ray imaging had a positive predictive value of 20% with a negative predictive value of 81%. A total of 55 CT examinations were performed on all patients with a mean effective dose of 2 mSv (low dose) versus 9.3 mSv (standard dose). The visibility of packets on low-dose CT images compared to high-dose CT was not reduced: the radiologists identified 385 and 381 of the packets, respectively, with no difference regarding the examination technique (p = 0.24 and p = 0.253, respectively). The radiodensity of all drug-filled packets at CT ranged from 26-292 HU (mean 181.2 HU). CONCLUSION: X-ray imaging of supposed body packers leads to a significant risk of diagnostic errors and additional need for CT. Instead, a single abdominal low-dose CT examination will deliver the correct diagnoses in most cases, leading to safe clinical management of the suspects.

Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies.

OBJECTIVE: To determine whether a 3 × 2 table, using an intention to diagnose approach, is better than the "classic" 2 × 2 table at handling transparent reporting and non-evaluable results, when assessing the accuracy of a diagnostic test. DESIGN: Based on a systematic search for diagnostic accuracy studies of coronary computed tomography (CT) angiography, full texts of relevant studies were evaluated to determine whether they could calculate an alternative 3 × 2 table. To quantify an overall effect, we pooled diagnostic accuracy values according to a meta-analytical approach. DATA SOURCES: Medline (via PubMed), Embase (via Ovid), and ISI Web of Science electronic databases. ELIGIBILITY CRITERIA: Prospective English or German language studies comparing coronary CT with conventional coronary angiography in all patients and providing sufficient data for a patient level analysis. RESULTS: 120 studies (10,287 patients) were eligible. Studies varied greatly in their approaches to handling non-evaluable findings. We found 26 studies (including 2298 patients) that allowed us to calculate both 2 × 2 tables and 3 × 2 tables. Using a bivariate random effects model, we compared the 2 × 2 table with the 3 × 2 table, and found significant differences for pooled sensitivity (98.2 (95% confidence interval 96.7 to 99.1) v 92.7 (88.5 to 95.3)), area under the curve (0.99 (0.98 to 1.00) v 0.93 (0.91 to 0.95)), positive likelihood ratio (9.1 (6.2 to 13.3) v 4.4 (3.3 to 6.0)), and negative likelihood ratio (0.02 (0.01 to 0.04) v 0.09 (0.06 to 0.15); (P<0.05)). CONCLUSION: Parameters for diagnostic performance significantly decrease if non-evaluable results are included by a 3 × 2 table for analysis (intention to diagnose approach). This approach provides a more realistic picture of the clinical potential of diagnostic tests.

Physical accessibility in primary health care settings: results from California on-site reviews.

BACKGROUND: People with disabilities report physical barriers in doctors' offices that affect the quality of care. Whether most or few doctors' offices are accessible is not known. We address this gap with data on 2389 primary care provider facilities. OBJECTIVES: The analysis seeks to describe overall primary care office physical accessibility and identify (1) in which areas offices meet access criteria, (2) which accessibility criteria are most often not met, and (3) whether there are urban/non-urban differences. METHODS: Reviewers rated medical offices using a 55-item instrument that assessed parking, exterior access, building entrance, interior public spaces, doctor's office interior, and the presence of accessible exam equipment. Five health plans that serve California Medicaid patients conducted reviews of providers signed with their plans. Data from the plans were merged, coded, and a descriptive analysis conducted. RESULTS: An accessible weight scale was present in 3.6% and a height adjustable examination table in 8.4% of the sites. Other high prevalence access barriers were in bathrooms and examination rooms. Parking, exterior access, building access, and interior public spaces generally met the access criteria, except for van accessible parking. CONCLUSIONS: These findings provide a base for quantitative expectations about accessibility nationwide, and indicate significant barriers exist. They show it is possible to conduct a large number of accessibility site reviews, providing one model to meet the Affordable Care Act requirement for provider accessibility information. Physical access is important as it may affect the quality of care and willingness of patients to engage in preventive care.

The use of a vertical arm support device to reduce upper extremity muscle firing in sonographers.

Work-related musculoskeletal disorders (WRMSD) in sonographers have increased over the past 20 years with shoulder injuries being the most prevalent. Advancing ultrasound technologies have reduced a sonographer's need to move when performing exams and increased prolonged arm abduction, resulting in static work postures and decreased joint perfusion. Work modifications in other industries have demonstrated that reducing arm abduction to 30° reduces muscle firing and fatigue. Although this is the ideal work posture for sonographers, there are many instances in which excessive arm abduction and static postures cannot be avoided. These positions are further complicated by the fact that the scanning arm is also supporting the weight of the ultrasound transducer. This observational case study evaluated the use of a moveable arm support system as a means to provide support for the scanning arm and reduce muscle firing during ultrasound exams in the scanning lab of a university diagnostic ultrasound educational program.

Automatic patient table removal in CT images.

In many medical imaging applications, it is desirable and important to localize and remove the patient table from CT images. However, existing methods often require user interactions to define the table and sometimes make inaccurate assumptions about the table shape. Due to different patient table designs, shapes, and characteristics, these methods are not robust in identifying and removing the patient table. This paper proposes a new automatic approach which first identifies and locates the patient table in the sagittal planes and then removes it from the axial planes. The method has been tested successfully against different tables in different products from multiple vendors, showing it is both a versatile and robust technique for patient table removal.