Methodological Challenges in Randomized Controlled Trials of mHealth Interventions: Cross-Sectional Survey Study and Consensus-Based Recommendations.

Background: Mobile health (mHealth) refers to using mobile communication devices such as smartphones to support health, health care, and public health. mHealth interventions have their own nature and characteristics that distinguish them from traditional health care interventions, including drug interventions. Thus, randomized controlled trials (RCTs) of mHealth interventions present specific methodological challenges.

The Impact of Scripted Self-Hypnotic Relaxation on the Periprocedural Experience and Anesthesiologist Sedation Use in the Pediatric Cardiac Catheterization Suite: A Prospective Randomized Controlled Trial.

Purpose: To assess the impact on children of self-hypnotic relaxation scripts read by trained staff prior to the induction of anesthesia and/or extubation on the periprocedural experience.

Patients And Methods: A total of 160 children aged 7-18 years undergoing a cardiac catheterization intervention under general anesthesia were randomized into 4 groups: (1) a pre-procedure (PP-script) read prior to entering the procedural room, (2) a script read prior to extubation (PX-Script), (3) both PP- and PX-Scripts read and (4) no script read. Anxiety and pain were rated on self-reported 0-10 scales.

Does Patient Satisfaction Drive Volumes in Outpatient Magnetic Resonance Imaging?

Objective: To help quantify the potential microeconomic impact of patient satisfaction in radiology, we tested the hypothesis that patient volume trends reflect patient satisfaction trends in outpatient magnetic resonance imaging (MRI).

Methods: Patient visits (N = 39,595) at distinct outpatient MRI sites within a university-affiliated hospital system during a 1-year period were retrospectively analyzed. Individual sites were grouped as having "decreasing," "stable," or "increasing" volume using an average quarterly volume change threshold of 5%.

The dosimetric benefit of in-advance respiratory training for deep inspiration breath holding is realized during daily treatment in left breast radiotherapy: A comparative retrospective study of serial surface motion tracking.

Introduction: A novel approach of in-advance preparatory respiratory training and practice for deep inspiration breath holding (DIBH) has been shown to further reduce cardiac dose in breast cancer radiotherapy patients, enabled by deeper (extended) DIBH. Here we investigated the consistency and stability of such training-induced extended DIBH after training completion and throughout the daily radiotherapy course.

Methods: Daily chestwall motion from real-time surface tracking transponder data was analysed in 67 left breast radiotherapy patients treated in DIBH.

Efficacy of a Self-Hypnotic Relaxation App on Pain and Anxiety in a Randomized Clinical Trial: Results and Considerations on the Design of Active and Control Apps.

Despite an explosion of mobile app offerings for management of pain and anxiety, the evidence for effectiveness is scarce. Placebo-controlled trials are the most desirable but designing inactive placebo apps can be challenging. For a prospective randomized clinical trial with 72 patients in a craniofacial pain center, we created an app with self-hypnotic relaxation (SHR) for use with iOS and Android systems.

Communication and Team Interactions to Improve Patient Experiences, Quality of Care, and Throughput in MRI.

Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients' awareness of what to expect during MRI and therefore mitigate anticipatory anxiety.

Prevalence and Financial Impact of Claustrophobia, Anxiety, Patient Motion, and Other Patient Events in Magnetic Resonance Imaging.

Claustrophobia, other anxiety reactions, excessive motion, and other unanticipated patient events in magnetic resonance imaging (MRI) not only delay or preclude diagnostic-quality imaging but can also negatively affect the patient experience. In addition, by impeding MRI workflow, they may affect the finances of an imaging practice. This review article offers an overview of the various types of patient-related unanticipated events that occur in MRI, along with estimates of their frequency of occurrence as documented in the available literature.

Economics of MRI Operations After Implementation of Interpersonal Skills Training.

Purpose: Examine the cost of MRI operations before and after implementation of interpersonal skills training to reduce unanticipated patient-related events in an academic medical center.

Methods: Teams at four MRI sites (two hospital-based, two freestanding) were trained in evidence-based communication skills in February to April 2015. Training was designed to enable staff members to help patients mobilize their innate coping skills in response to any distress they experienced during their MRI visit.

Helping Children Cope with Medical Tests and Interventions.

Medical procedures and tests become a challenge when anxiety and pain make it difficult for the patient to cooperate or remain still when needed. Fortunately a short intervention with hypnoidal language at the onset of a procedure induces a positive and sustained change in the way pain and anxiety are processed. While anesthesia may appear to be a simple solution to eliminate pain, the adverse effects of pre-anesthesia anxiety on postoperative behavior and recovery are often not fully appreciated.

Effects of Patients' Affect on Adverse Procedural Events during Image-Guided Interventions.

Purpose: To assess how a patient's affect on presentation relates to the likelihood of adverse events during their subsequent interventional image-guided procedures.

Materials And Methods: A secondary analysis was performed of an existing dataset from a clinical trial with 230 patients who underwent percutaneous peripheral vascular and renal interventions and who had completed the positive affect (PA) negative affect (NA) schedule (PANAS) before their procedures. Summary PANAS scores were split over the median and used to classify the participants into those with high vs low PA and high vs low NA.

Effects of Interpersonal Skills Training on MRI Operations in a Saturated Market: A Randomized Trial.

Purpose: The aim of this study was to assess the effects of team training on operational efficiency during outpatient MRI.

Methods: In this institutional review board-approved, HIPAA-compliant study, six MRI outpatient sites of a midwestern hospital system were randomized to serve as controls or have their teams trained in advanced communication skills. The fourth quarter of fiscal year 2015 was the trial baseline.

Effect of team training on improving MRI study completion rates and no-show rates.

Purpose: Magnetic resonance imaging (MRI) is a high-cost imaging modality, and an optimized encounter ideally provides high-quality care, patient satisfaction, and capacity utilization. Our purpose was to assess the effectiveness of team training and its impact on patient show-up and completion rates for their MRI examinations.

Materials And Methods: A total of 97,712 patient visits from three tertiary academic medical centers over 1-year intervals were evaluated, totaling 49,733 visits at baseline and 47,979 after training.

Analyzing acute procedural pain in clinical trials.

Because acute procedural pain tends to increase with procedure time, assessments of pain management strategies must take that time relationship into account. Statistical time-course analyses are, however, complex and require large patient numbers to detect differences. The current study evaluated the abilities of various single and simple composite measures such as averaged pain or individual patient pain slopes to detect treatment effects.

Understanding patient satisfaction ratings for radiology services.

Objective: Under the Hospital Value-Based Purchasing Program of the Centers for Medicare & Medicaid Services, patient satisfaction accounts for 30% of the measures of and payments for quality of care. Understanding what drives patient satisfaction data and how the data are obtained, converted into scores, and formulated into rankings is increasingly critical for imaging departments. The objectives of this article are to describe the potential impact of patient satisfaction ratings on institutions and individuals, explain how patient satisfaction is rated and ranked, identify drivers that affect the ratings and rankings, and probe the resulting challenges unique to radiology departments.

A Better Patient Experience Through Better Communication.

The transformation of healthcare from a seller's market to a consumer's market has pushed the element of patient satisfaction into the forefront of various medical facility evaluation tools, including those used by Medicare when weighing reimbursement to hospitals for patient care. Research has identified good communication skills to be a key factor in ensuring better patient outcomes, and nurturing patient satisfaction. Because of the growing amount of money at stake for patients' satisfaction with a facility, the communication skills of individual healthcare providers are bound to impact their employees' reimbursement, bonuses, and promotion options.

Managing distress, discomfort, and anxiety in imaging.

Positive patient interactions and experiences not only help the customer but also directly affect the bottom line. Waste of overhead can be limited by simply changing the way staff talks with patients. It is important to include rapid rapport skills and ways to positively shape the patients' experience right from the start instead of waiting and possibly having a procedure or scan disrupted.

Distress in the radiology waiting room.

Purpose: To assess the level of distress in women awaiting radiologic procedures.

Materials And Methods: In this institutional review board-approved and HIPAA-compliant study, 214 women between 18 and 86 (mean, 47.9) years of age completed the State Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Center for Epidemiologic Studies Depression Scale (CES-D), and Perceived Stress Scale (PSS) immediately prior to their procedures.

Effect of team training on patients' ability to complete MRI examinations.

Rationale And Objectives: Assess whether staff training in advanced rapport skills and self-hypnotic relaxation techniques reduces noncompletion rates during magnetic resonance imaging (MRI).

Methods And Materials: All staff of a free-standing MRI facility was invited to 3 hours of preparatory communication lectures. Half of the practice was then engaged in intensive training.

In vitro analysis of downstream particulates with mechanical thrombectomy devices: comparison of 20-kHz sonothrombolytic and rotating dispersion wire systems.

Purpose: To assess the potential of macroembolization, the authors compared the downstream particulate profile generated with use of two thrombectomy devices, a 20-kHz ultrasound-based sonothrombolytic (ST) device and a rotating dispersion wire (RDW).

Materials And Methods: An arterial flow model was pressurized to 100 mm Hg and perfused with 1,000 mL/min normal saline. Tubing containing 7-mm x 30-cm bovine thrombus proximal to a 75% stenosis was inserted distal to a nonstenosed bypass.

Large-core breast biopsy: abnormal salivary cortisol profiles associated with uncertainty of diagnosis.

Purpose: To determine whether uncertainty of the diagnosis after large-core breast biopsy (LCBB) adversely affects biochemical stress levels.

Materials And Methods: This study was institutional review board approved and HIPAA compliant, and all patients gave written informed consent. One hundred fifty women aged 18-86 years collected four salivary cortisol samples per day for 5 days after LCBB.

Hemolysis comparison between the OmniSonics OmniWave Endovascular System and the Possis AngioJet in a porcine model.

Purpose: To compare the degree of hemolysis generated during use of the ultrasound-based OmniSonics OmniWave Endovascular System and the Possis AngioJet connected to an Xpeedior-6 catheter.

Materials And Methods: Twelve 64-145-kg Yorkshire pigs were used as the model because their weight, blood volume, and vessel diameters are comparable to that of adult humans. Six pigs were treated with the OmniWave and six with the AngioJet; half of the pigs in each group were treated in the contralateral iliofemoral arteries and half in the ipsilateral iliofemoral veins.

Practical hypnotic interventions during invasive cancer diagnosis and treatment.

Novel advances in biotechnology and medical imaging techniques have enabled an evolution toward earlier diagnosis and treatment by way of "minimally invasive" surgical techniques performed on the conscious patient without the use of general anesthesia. Although the risks of diagnostic and therapeutic interventions have been reduced with these approaches, patients still face many physical and psychologic challenges. Several randomized controlled trials have shown that hypnotic techniques are effective in reducing pain, anxiety, and other symptoms; in reducing procedure time; and in stabilizing vital signs.

Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice.

Purpose: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events.

Materials And Methods: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication.