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Thứ Tư, 9 tháng 10, 2019

POCUS, MRI make ECRI's top 10 hazards list

By Kate Madden Yee, AuntMinnie.com staff writer
October 9, 2019 -- Point-of-care ultrasound (POCUS) and missing patient implant data for MRI exams are listed among the top 10 health technology hazards for 2020, according to a new report released October 7 by healthcare consultancy ECRI Institute.

POCUS scanners are portable, relatively inexpensive, and easy to use -- all features that have contributed to their rapid adoption into clinical practice, ECRI noted. But POCUS's speedy implementation has "outpaced policies and practices that could prevent misuse or misdiagnosis," the institute said.
Safety concerns around POCUS include using the technology inappropriately, misdiagnoses, and overdependence on portable ultrasound when a patient really needs a more comprehensive imaging exam.
"Safeguards for ensuring that POCUS users have the requisite training, experience, and skill have not kept pace with the speed of adoption," ECRI said. "The lack of sufficient oversight increases the potential that patients will be adversely affected by problems associated with use, or lack of use, of the technology."
The institute suggests that POCUS quality assurance policies should address user training and credentialing, exam documentation, and data archiving.
As for MRI, the report calls specific attention to missing patient implant data, which can put patients in danger and delay MRI exams.
"Some implants can heat, move, or malfunction when exposed to an MRI system's magnetic field," the ECRI said. "Thus, MRI staff must identify and follow any contraindications or conditions for safe scanning prescribed by the implant manufacturer."
But information about patient implants can be difficult to track down, since there is often no single place within the electronic health record (EHR) to make note of it, according to ECRI.
"Direct harm to the patient is possible if a scan is inappropriately conducted in the presence of an unidentified implant," the ECRI said. "Also, the patient's treatment can be adversely affected if a scan needs to be postponed while care providers search for implant information. Healthcare facilities should work with their EHR provider to create an implant list stored within the patient record."
Other hazardous issues on the ECRI list include surgical stapler misuse, sterile processing errors in medical and dental offices, unproven surgical robotic procedures, medication timing errors in patient EHRs, and loose nuts and bolts in medical equipment.
"[This] list identifies the potential sources of danger that we believe warrant the greatest attention for the coming year," ECRI said. "The list does not enumerate the most frequently reported problems or the ones associated with the most severe consequences -- although we do consider such information in our analysis. Rather, the list reflects our judgment about which risks should receive priority now."

Elastography helps liver transplant patients avoid biopsy.

By Kate Madden Yee, AuntMinnie.com staff writer
October 8, 2019 -- Ultrasound with a shear-wave elastography (SWE) technique can help liver transplant patients avoid biopsy on follow-up, according to a study published online October 7 in the American Journal of Roentgenology.
The findings are good news for a patient population often vulnerable to invasive procedures after transplant -- and can help save healthcare resources, wrote a team led by Dr. Corinne Deurdulian of the University of Southern California in Los Angeles.
"Given the significant resources allotted to perform liver biopsies (e.g., radiologist time, nursing staff, and hospital resources) and patient recovery time, as well as patient discomfort and the possibility of significant postbiopsy complications developing, utilization of a noninvasive tool to determine the degree of hepatic fibrosis would be useful in the initial assessment and follow-up of liver transplant patients," the group wrote.
After liver transplant, patients are monitored for both possible rejection of the new organ and hepatic fibrosis, and they often undergo liver biopsies as part of this follow-up, Deurdulian and colleagues noted.
The researchers sought to determine whether shear-wave elastography could offer a noninvasive alternative to biopsy to assess for liver fibrosis, helping clinicians quantify it in liver transplant recipients.
The study included 111 adult liver transplant patients who underwent 147 SWE exams of the right hepatic lobe followed by biopsies between May 2015 and December 2017. The researchers compared SWE values with fibrosis scores of biopsy samples using the Metavir system: Metavir scores are F0 (no fibrosis), F1 (portal fibrosis without septa), F2 (portal fibrosis with few septa), F3 (numerous septa without cirrhosis), and F4 (cirrhosis). The team tracked SWE's sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy.
Of the 147 SWE exams and liver biopsies, the researchers found consistent threshold values for patients with Metavir scores of F0 and F1 (no or minimal fibrosis), compared with those with Metavir scores of F2, F3, or F4 (significant fibrosis).
SWE's performance in classifying fibrosis
Performance measureSWE
SWE value
No or minimal fibrosis≤ 1.76 m/sec
Significant fibrosis> 1.76 m/sec
Other performance measures
Positive predictive value33%
Negative predictive value96%
The study results suggest that clinical decisions for liver transplant patients can be based on SWE results rather than biopsy, the researchers concluded.
"If the median SWE value is 1.76 [m/sec] or less, the patient can be classified as having no or minimal fibrosis ... and can avoid biopsy," the group concluded. "According to these results, which have a negative predictive value of 96%  liver biopsies may be obviated in most patients."