Using Technology for Prescription and Adherence in an Alzheimer’s Prevention Program

Healthy lifestyle change is difficult to adopt and maintain without support. Often physicians recommend exercise to their patients, but have limited means to support this change. A major goal of our study is to provide physicians with a simple method of referring patients to a program that supports adoption and maintenance of exercise that meets recommended guidelines for older adults. The Lifestyle Empowerment for Alzheimer’s Prevention program (LEAP! Rx) is a yearlong intervention to support cognitively normal older adults in adoption and maintenance of moderate to vigorous exercise, a key prevention factor for Alzheimer’s disease. The program uses the electronic medical record and builds relationships with physicians to identify patients eligible to participate. It electronically communicates about patients’ progress back to referring physicians to facilitate ongoing physician-patient interaction. Participants receive exercise coaching to reach their weekly exercise goals and have access to online lifestyle education classes (e.g., nutrition, sleep, stress management). The study is currently enrolling (n= 121 enrolled; mean age 71.4; 12% non-white, 4% Hispanic/Latino, and 83% female). Physician referrals originate from five clinics represented by 48 physicians. The study design will actively compare the physician referral process to self-referrals from the community (n=20). We have adapted the protocol to the conditions of the pandemic including online exercise coaching and support. This presentation will discuss successes and lessons learned from this novel method of recruitment and adherence to exercise.

The AflibeRcept use in rEal life study for the treatment of diabetiC macular oedema In the French overseas territories: A 12 months follow-up Study - The RECIF Study

Purpose The incidence and severity of diabetes is particularly high in the French overseas territories (FOT). The RECIF study evaluated real life management of diabetic macular oedema (DME) treated by aflibercept in FOT. Methods A prospective, noncomparative, multicentric, non-interventional, study that evaluated functional and anatomical results of patients treated by aflibercept. Twelve retina specialists working in French Polynesia, La Reunion, Guadeloupe and Martinique participated in the study. Results 67 eyes of 57 patients were followed for 12 months. Average VA gain was 7.8 ETDRS letters. 29.9% of eyes gained at least 15 letters, 6% lost 15 letters or more. 67.2% of eyes achieved visual acuity of 70 letters or better. Average central retinal thickness decrease was 115.3 µm. The mean number of injections during the 1st year of treatment was 4.9. 69% of eyes had a loading dose of at least three-monthly injections. 3 eyes were switched to steroid injections during the follow-up for lack of efficacy. Conclusion This study confirmed the efficacy of intravitreal treatment of DME by aflibercept, in the French overseas territories. This evaluation of real-life management of DME underlines the importance of improvement of patient education and collaboration with referring physicians.

PHYSICIAN PERCEPTION ON COMMON HAND CONDITION, AND THEIR REFERRAL PATTERN

Background:Several hand conditions have an overlap in term of management by surgeons from different departments. They usually rely on referrals from general health providers. Suitable referral depends on the knowledge and understanding of the referring physicians to the problem and the best available treatment. Recently the number of referrals and operations of elective hand surgeries increased by more than 30%. Physician from different specialties can sometimes disagree on their perception on what is the best treatment option for the patient. Aim: to study physicians perception on common hand condition, and their referral pattern. Material and Method: The research was conducted using a survey with a sample size of 102 focusing on health care providers from King Abdul-Aziz University Hospital and they were collected by convenience sampling. The raw data was collected in an excel sheet. We used SPSS statistics 21st for quantitative data analysis. Results: The results gave us a general idea that there is a lot of difference of understanding to the hand conditions and which should be referred to where, with orthopedic being the most referred to Speciality. Conclusion: Referral for different hand and wrist conditions remains unclear to many practicing physicians at our institute. Establishment of a separate hand and wrist unit/clinic that includes all individual specializations may help improve patient care and wait timing.

Computed Tomography Structured Reporting in the Staging of Lymphoma: A Delphi Consensus Proposal

Structured reporting (SR) in radiology is becoming increasingly necessary and has been recognized recently by major scientific societies. This study aims to build structured CT-based reports for lymphoma patients during the staging phase to improve communication between radiologists, members of multidisciplinary teams, and patients. A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology (SIRM), was established. A modified Delphi process was used to develop the SR and to assess a level of agreement for all report sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to measure quality analysis according to the average inter-item correlation. The final SR version was divided into four sections: (a) Patient Clinical Data, (b) Clinical Evaluation, (c) Imaging Protocol, and (d) Report, including n = 13 items in the “Patient Clinical Data” section, n = 8 items in the “Clinical Evaluation” section, n = 9 items in the “Imaging Protocol” section, and n = 32 items in the “Report” section. Overall, 62 items were included in the final version of the SR. A dedicated section of significant images was added as part of the report. In the first Delphi round, all sections received more than a good rating (≥3). The overall mean score of the experts and the sum of score for structured report were 4.4 (range 1–5) and 1524 (mean value of 101.6 and standard deviation of 11.8). The Cα correlation coefficient was 0.89 in the first round. In the second Delphi round, all sections received more than an excellent rating (≥4). The overall mean score of the experts and the sum of scores for structured report were 4.9 (range 3–5) and 1694 (mean value of 112.9 and standard deviation of 4.0). The Cα correlation coefficient was 0.87 in this round. The highest overall means value, highest sum of scores of the panelists, and smallest standard deviation values of the evaluations in this round reflect the increase of the internal consistency and agreement among experts in the second round compared to first round. The accurate statement of imaging data given to referring physicians is critical for patient care; the information contained affects both the decision-making process and the subsequent treatment. The radiology report is the most important source of clinical imaging information. It conveys critical information about the patient’s health and the radiologist’s interpretation of medical findings. It also communicates information to the referring physicians and records this information for future clinical and research use. The present SR was generated based on a multi-round consensus-building Delphi exercise and uses standardized terminology and structures, in order to adhere to diagnostic/therapeutic recommendations and facilitate enrolment in clinical trials, to reduce any ambiguity that may arise from non-conventional language, and to enable better communication between radiologists and clinicians.

Cardiovascular Magnetic Resonance in Ischemic Heart Disease

Ischemic heart disease is one of the leading causes of death and disability, limiting individual’s quality of life. Cardiac magnetic resonance is radiation-free tool to image IHD patients and can depict inducible ischemia, extent and distribution of scar burden, associated complications like mitral regurgitation, thrombus, aneurysm formation, myocardial rupture, and any other incidental pathology. With increasing availability of the CMR there is an ever increasing need to interpret these images by non-imaging clinicians in order to manage patients more effectively. In this article, image interpretation for detection of ischemia, infarct and thrombus are discussed in simple easy to understand manner leaving behind intricate technical details which are of less important to the referring physicians.

PSMA-PET/CT Registry for Recurrent Prostate Cancer (PREP): Initial findings from a single center.

5064 Background: Several lesion-targeted therapies exist for locally recurrent or limited stage metastatic prostate cancer (PCa) post-radiotherapy (RT) and radical prostatectomy (RP). However, detection of disease sites is limited using conventional imaging (CI) including computed tomography (CT) and bone scan. Prostate specific membrane antigen (PSMA) targeting PET radiopharmaceuticals like [18F]DCFPyL may help detect disease not seen on CI. Our objective was to assess the ability of PSMA targeted PET/CT to detect sites of disease recurrence and impact on patient management. Methods: This multi-center prospective registry study included six Ontario centers. Eligible patients in 1 of 7 clinical cohorts (Table) were identified and approved by Cancer Care Ontario (CCO) to have restaging with PSMA targeted PET/CT. Referring physicians were asked to complete a form indicating whether a change in management strategy would occur based on the PET/CT results. At 6 months post-PET/CT, actual patient management will be confirmed via provincial registries. These interim results are from a single center. Results: 253 patients were enrolled and had a PSMA targeted PET/CT. At baseline, median age was 71 years (range 50-102 years) and median PSA was 2.7 ng/mL (range 0.04-134.0 ng/mL). The majority of patients (n=59; 23.3%) were in cohort 2 (biochemical failure post-RP). In patients with negative CI, PSMA targeted PET/CT detected disease sites in 68.5% (170/248), resulting in a change in management for 67.8% (137/202) overall and 72.1% and 64.3% post-RT and post-RP, respectively. Conclusions: PSMA targeted PET/CT detected occult lesions on CI in the majority of patients enrolled, leading to a high rate of change in management. Our institutional results are in keeping with preliminary results reported for the provincial cohort. Clinical trial information: NCT03718260. [Table: see text]

Which Aspects of the CanMEDS Competencies are Most Valued in Radiologists? Perspectives of Trainees From Other Specialties

Purpose: Radiologists work primarily in collaboration with other healthcare professionals. As such, these stakeholder perspectives are of value to the development and assessment of educational outcomes during the transition to competency-based medical education. Our aim in this study was to determine which aspects of the Royal College CanMEDS competencies for diagnostic radiology are considered most important by future referring physicians. Methods: Institutional ethics approval was obtained. After pilot testing, an anonymous online survey was sent to all residents and clinical fellows at our university. Open-ended questions asked respondents to describe the aspects of radiologist service they felt were most important. Thematic analysis of the free-text responses was performed using a grounded theory approach. The resulting themes were mapped to the 2015 CanMEDS Key Competencies. Results: 115 completed surveys were received from residents and fellows from essentially all specialties and years of training (out of 928 invited). Major themes were 1) timeliness and accessibility of service, 2) quality of reporting, and 3) acting as a valued team member. The competencies identified as important by resident physicians were largely consistent with the CanMEDS framework, although not all key competencies were covered in the responses. Conclusions: This study illustrates how CanMEDS roles and competencies may be exemplified in a concrete and specialty-specific manner from the perspective of key stakeholders. Our survey results provide further insight into specific objectives for teaching and assessing these competencies in radiology residency training, with the ultimate goal of improving patient care through strengthened communication and working relationships.

Impact of a Virtual Multidisciplinary Sarcoma Case Conference on Treatment Plan and Survival in a Large Integrated Healthcare System

PURPOSE: Quantifying the impact of a multidisciplinary cancer case conference on patient outcome and care quality remains challenging. PATIENTS AND METHODS: We prospectively investigated the impact of our virtual multidisciplinary sarcoma case conference (VMSCC) on treatment plan in patients presented to the VMSCC from July to October 2020 (prospective cohort) and retrospectively in patients with metastatic or locally advanced high-grade soft-tissue sarcoma (STS) reviewed in the VMSCC in 2016 and 2017 (high-grade STS cohort). We also investigated the factors related to the nonadherence to the VMSCC-recommended plan in both cohorts. RESULTS: In both cohorts, approximately 28% of the patients were referred to the VMSCC for review without a treatment plan. In significantly more cases, referring physicians outside of the sarcoma group did not have a plan formulated before the VMSCC review compared with the referring physicians within the sarcoma group. In 28.2% (prospective cohort) and 19.5% (high-grade STS cohort) of the patients, VMSCC recommended a different plan. The adherence to the VMSCC-recommended plan was 87.9% and 83.1%, respectively. The causes of the nonadherence were primarily due to disease progression or patient’s decision against recommended therapy. The median overall survival for the high-grade STS cohort was 26 months. CONCLUSION: VMSCC affected the treatment plan in approximately 50% of the patients in both cohorts. The median overall survival of the patients with high-grade STS reviewed by the VMSCC in our cohort is comparable with the literature.

Cumulative effective dose from recurrent CT examinations in Europe: proposal for clinical guidance based on an ESR EuroSafe Imaging survey

In recent years, the issue of cumulative effective dose received from recurrent computed tomography examinations has become a subject of increasing concern internationally. Evidence, predominantly from the USA, has shown that a significant number of patients receive a cumulative effective dose of 100 mSv or greater. To obtain a European perspective, EuroSafe Imaging carried out a survey to collect European data on cumulative radiation exposure of patients from recurrent computed tomography examinations. The survey found that a relatively low percentage of patients (0.5%) received a cumulative effective dose equal to or higher than 100 mSv from computed tomography, most of them having an oncological disease. However, there is considerable variation between institutions as these values ranged from 0 to 2.72%, highlighting that local practice or, depending on the institution and its medical focus, local patient conditions are likely to be a significant factor in the levels of cumulative effective dose received, rather than this simply being a global phenomenon. This paper also provides some practical actions to support the management of cumulative effective dose and to refine or improve practice where recurrent examinations are required. These actions are focused around increasing awareness of referring physicians through encouraging local dialogue, actions focused on optimisation where a team approach is critical, better use of modern equipment and the use of Dose Management and Clinical Decision Support Systems together with focused clinical audits. The proper use of cumulative effective dose should be part of training programmes for referrers and practitioners, including what information to give to patients. Patient summary Radiation is used to the benefit of patients in diagnostic procedures such as CT examinations, and in therapeutic procedures like the external radiation treatment for cancer. However, radiation is also known to increase the risk of cancer. To oversee this risk, the cumulative effective dose (CED) received by a patient from imaging procedures over his or her life is important. In this paper, the authors, on behalf of EuroSafe Imaging, report on a survey carried out in Europe that aims to estimate the proportion of patients that undergo CT examinations and are exposed to a CED of more than 100 mSv. At the same time, the survey enquires about and underlines radiologists’ measures and radiology departments’ strategies to limit such exposure. Over the period of 2015–2018, respondents reported that 0.5% (0–2.72%) of patients were exposed to a CED of ≥ 100 mSv from imaging procedures. The background radiation dose in Europe depends on the location, but it is around 2.5 mSv per year. It is obvious that patients with cancer, chronic diseases and trauma run the highest risk of having a high CED. However, even if the number of patients exposed to ≥ 100 mSv is relatively low, it is important to lower this number even further. Measures could consist in using procedures that do not necessitate radiation, using very low dose procedures, being very critical in requiring imaging procedures and increasing awareness about the issue. Key Points • A relatively low percentage of patients (0.5%) received a cumulative effective dose from CT computed tomography equal to or greater than 100 mSv, in Europe, most of them having an oncological disease. • There is a wide range in the number of patients who receive cumulative effective dose equal to or greater than 100 mSv (0–2.72%) and optimisation should be improved. • Increasing the awareness of referring physicians through encouraging local dialogue, concrete actions focused on optimisation and development of dose management systems is suggested.

How Patients Choose a Laryngologist: A Pilot Stated Preference Study

Objective Patients consider many factors when deciding how to receive medical care. This study used best-worst scaling (BWS), a technique novel to otolaryngology, to quantitatively examine preferences among patients choosing a laryngologist. Our objective was to quantify in a pilot cohort the relative importance patients place on a variety of attributes when seeking a laryngologist. Study Design BWS survey. Setting Academic voice clinic. Methods New patients were recruited to take a computerized BWS survey developed using attributes derived from patient input, expert opinion, and literature review. Attributes were grouped into 4 categories: physician reputation, physician qualifications, hospital-related factors, and other nonclinical factors. Responses were analyzed using multinomial logit regression to determine importance scores and associations with other variables. Results Eighty-seven of 93 patients recruited participated (93.5% response rate). Physician qualifications were the most important attributes to patients, with specialty laryngology training receiving the highest importance score (20.8; 95% CI, 20.2 to 21.5; P < .0001). Recommendations from referring physicians (15.6; 95% CI, 14.3 to 16.9) and use of cutting-edge technology (11.9; 95% CI, 10.7 to 13.1) were the second and third most important, respectively. Least important were nonclinical factors, including wait time to get an appointment (4.3; 95% CI, 2.8 to 5.8) and convenience of office location (1.5; 95% CI, 0.9 to 2.1). Just over half of patients (51.2%) reported willingness to wait 4 weeks for an appointment with a laryngologist. Older patients were less concerned with convenience-related factors. Conclusion Nonclinical factors were less important to patients than clinical factors, and laryngology-specific training was paramount. Stated preference methodologies can elucidate underlying preferences and help providers make care more patient centered.