Change In Overall Time Research Articles

Impact of imaging nurse navigation on breast interventions: Direct and closed-loop patient communication and documentation

ObjectiveA breast imaging nurse navigator (NN) was established with the goals to enhance the patient experience after biopsy, improve care timeliness, accuracy, and coordination, facilitate direct communication to patients, and increase care retention within our system. Our aim was to determine the impact of NN on patient care time metrics, communication, documentation, compliance, and care retention at our institution after breast biopsy. MethodsRetrospective review of a six-month period before (5/1/17–10/31/17) and after (5/1/19–10/31/19) establishment of a nurse navigator in our breast imaging department was performed, including 498 patients in the pre-navigation (pre-NN) group and 526 patients in the post-navigation (post-NN) group. Data was gathered from the electronic medical record and collected using REDCap. ResultsBiopsy pathology results were communicated directly to the patient more often post-NN (71%, 374/526) compared to pre-NN (4%, 21/498) (p < 0.0001), without change in overall time of result communication (p = 0.08). Due to factors outside of imaging, most care time metrics were longer post-NN, including days from biopsy to pathology report (p < 0.001), result communication to initiation of care (p < 0.001), and biopsy to surgery (p < 0.001). There was no difference and high compliance (p = 1) and care retention (p = 0.015) in both groups. There was improved documentation of pathology results, recommendations, and communication post-NN (0/526 vs 10/498, p = 0.001). ConclusionImaging nurse navigation added greatest value by communicating breast biopsy results and recommendations directly to patients and ensuring documentation. Compliance and retention were high in both groups. Factors outside of Radiology influenced time metrics, requiring further investigation of multidisciplinary collaboration.

Primary total knee replacement leads to an increase in physical activity but no changes in overall time of sedentary behaviour: a retrospective cohort study using an accelerometer.

There is no consensus between patient-reported subjective scores and objectively measured physical activity (PA) behaviour after total knee arthroplasty (TKA). The aim of this study was to understand the volume and pattern of physical activity and daily energy consumption after total knee arthroplasty for osteoarthritis. Physical activity patterns of 36 patients (31 female, 5 male) with an average age of 67.3 ± 6.7 (50-81) years and end-stage gonarthrosis were investigated using an accelerometer (ActiCal) for seven consecutive days prior to and six months after total knee arthroplasty. Knee Society scores, Oxford knee scores, range of motion, and muscle strength around knee were also recorded. Sedentary behaviour did not change after total knee arthroplasty (p= 0.975). Increases in light physical activity time (p= 0.005) and moderate-vigorous physical activity time (p= 0.006) were found significant. In the post-operative period, light PA awake time increased 25% and moderate-vigorous PA awake time increased four times compared with the pre-operative value. In addition, a significant increase was observed in the amount of daily energy expenditure after TKA (p= 0.001). The subjective functional scores were increased in the post-operative period compared with baseline values (p< 0.001). While a significant increase in knee flexion angle was found after TKA (p= 0.01), there was no increase in muscle strength around the knee (p= 0.096). Accumulation patterns of activity evaluated by using an accelerometer objectively can give a new insight to realize the behavioral changes after total knee arthroplasty. Daily life style changes can be encouraged by means of objective evaluations.

Reducing RN Vacancy Rate: A Nursing Recruitment Office Process Improvement Project.

The aim of this study was to reduce the RN vacancy rate at an academic medical center by improving the hiring process in the Nursing Recruitment Office. Inability to fill RN positions can lead to higher vacancy rates and negatively impact staff and patient satisfaction, quality outcomes, and the organization's bottom line. The Model for Improvement was used to design and implement a process improvement project to improve the hiring process from time of interview through the position being filled. Number of days to interview and check references decreased significantly, but no change in overall time to hire and time to fill positions was noted. RN vacancy rate also decreased significantly. Nurse manager satisfaction with the hiring process increased significantly. Redesigning the recruitment process supported operational efficiencies of the organization related to RN recruitment.

The aspect of nationality in participation and performance at the ‘Powerman Duathlon World Championship’ – The ‘Powerman Zofingen’ from 2002 to 2011

We investigated participation and performance trends in duathletes in the ‘Powerman Duathlon World Championship’ in Zofingen, Switzerland, from 2002 to 2011, regarding the nationality of the finishers. Sex and nationality at the time of the competition and overall race times of both women and men finishers at the ‘Powerman Zofingen’ (10 km run, 150 km cycle, 30 km run) were analysed from 2002 to 2011 using linear regression analysis. In total, 272 women and 1,964 men finished the race. Participation increased across years in women (r 2 =0.73, P 0.05). Most of the athletes originated from Switzerland, followed by participants from Germany, France, Italy, Belgium, the United States of America, Spain, Great Britain, the Netherlands and Denmark. Across the years, both German men (r 2 =0.55, P=0.01) and German women (r 2 =0.66, P<0.01) increased their participation. The top five athletes overall showed no changes in performance for both women and men where Swiss athletes achieved the fastest race times. Athletes from the five countries with the highest participation showed no changes in overall race time. To summarize, (i) European athletes from Switzerland and Germany dominated participation in the ‘Powerman World Championship’ where Swiss duathletes were the fastest and (ii) duathletes at world-class level showed no changes in performance in the last ten years. Future studies should investigate the participation and performance trends in other long distance duathlons of the ‘Powerman World Series’.

Improving Accuracy of Sleep Self-Reports Through Correspondence Training

Sleep insufficiency is a major public health concern, yet the accuracy of selfreported sleep measures is often poor. Self-report may be useful when direct measurement of nonverbal behavior is impossible, infeasible, or undesirable, as it may be with sleep measurement. We used feedback and positive reinforcement within a small-n multiple-baseline design to improve the accuracy with which young adults reported the amount of time they spent awake during sleep hours. Feedback and contingent money resulted in improved accuracy of self-reports but no change in overall time spent awake.

Clinical evidence for tumor clonogen regeneration: interpretations of the data

A therapeutic gain is expected from accelerated fractionation in radiotherapy because of reduced times for proliferation of tumor clonogens and the likelihood that the late effects of radiation are unaffected by changes in overall time. While there can be no dispute over the existence of the phenomenon, there are questions about the ways clinical data have been interpreted to adduce the influence of proliferation. Moreover, recent clinical and experimental evidence throw some doubt on the assumption that late effects are independent of overall treatment time. It is concluded that some of the issues remain in doubt, and that rather large-sized phase-III trials may be required to show any benefit from reductions in the overall time, especially if this is accompanied by substantial reductions in the total dose.

Fractionation in radiation therapy

Variations in schedule from the usual 200 cGy daily, 5 days a week, for six or seven weeks, will be reviewed with both the radiobiological basis and clinical results so far. Hyperfractionated schedules (e.g., 1.15 Gy b.i.d. for 7 weeks) have given lo-15% better local control than the conventional 7-week schedule, with no extra late effects, both in Europe and USA. This is just as predicted in radiobiological grounds. Accelerated schedules (shorter overall times) are being tested in clinical trials (USA 6 weeks, Europe 5 weeks and UK 12 days). The effects of changing overall time or fraction size must be considered separately. Changes in overall time require changes in total (iso-effective) dose only if the tissue or tumour being considered is proliferating during the period of change. Therefore lengthening overall time allows both tumours and early-reacting tissues to protect themselves from damage by proliferating. There is little effect on late reactions from a change in overall time only. Shortening overall time will cause more damage to both tumour and early-reacting normal tissues because they proliferate less in the shorter overall time. Shortening overall time will have little effect on late reactions. The success of accelerated fractionation therefore depends upon the relative proliferation rates in tumours and early-reacting normal tissues. Recent advances in flow cytometry enable tumour proliferation to be measured within a day from biopsy. Accelerated fractionation will be necessary to achieve local control in some but not in all tumours. Within each tumour type there is a wide range of proliferation rates. Accelerated fractionation must not be achieved by using fewer and larger fractions than normal; this leads to excessive late damage. Tumour cells appear to respond as if they are rapidly proliferating. The relationship between total dose and dose-per-fraction can now be understood in terms of the greater curvature of the dose-response curve for late than for early reacting tissues. This is due to greater repair in those tissues for smaller doses per fraction, as if resting cells have more time to repair radiation injury. This is the rationale for hyperfractionation: a larger number of smaller dose fractions than normally. The late damage in normal tissues is spared more than the damage to early-reacting normal tissues and tumour cells. It is not essential to use the linear-quadratic formula to describe these relationships, but that formula is convenient and appears reliable between 1 and 10 Gy per fraction. The time factor must be considered separately from the dose-per-fraction factor. 'Juadratic formula as fo$lows. The surviving fraction S = e _b time factor can now be added to the Linear where: E = n(ad + Bd ) YT n = No of fractions d = size of each a/S = 2-5 Gy for late reactions = lo-20 Gy for tumor/early T = overall time Y = (log 2)/T where T = douglingPtime of cells T/T is the number of cell doublings. If proliferation doe!? not begin until the time Tk, replace T with (T-l?k). Flow cytometry suggests a range of 2-20 days for T , median 5 days. Some ways of combining the advantages of accelerafid and hyperfractionated schedules have been developed recently in clinical practice and will be discussed. Multiple fractions per day seem to be necessary for optimum schedules, but the intervals should be kept long, preferably 6 hours.