Digital Navigation Improves No-Show Rates and Bowel Preparation Quality for Patients Undergoing Colonoscopy: A Randomized Controlled Quality Improvement Study

OBJECTIVES

Because of high historical no-show rates and poor bowel preparation quality in our unit, we sought to evaluate whether text message navigation for patients scheduled for colonoscopy would reduce no-show rates and improve bowel preparation quality compared with usual care.

METHODS

We performed a randomized controlled quality improvement study from April to August 2019 in an urban academic endoscopy unit. All patients scheduled for colonoscopy were randomly assigned to a control group that received usual care (paper instructions/nursing precalls) or to the intervention group that received usual care plus the text message program [short message service (SMS)]. The program provided timed-release instructions on dietary modifications and bowel preparation before colonoscopy. The primary outcome was no-shows. Secondary outcomes were no-show/same-day cancellations, no-show/cancellations within 7 days of the procedure, and bowel preparation quality.

RESULTS

A total of 1625 patients were randomized (SMS=833, control=792). No-show rates were significantly lower in the SMS group compared with the control group (8% vs. 14%; P<0.0001). Similar results were found for no-show/same-day cancellations (10% vs. 16%; P=0.0003), and no-show/cancellations within 7 days (18% vs. 26%; P=0.0008). There was no difference in adequate bowel preparation for all colonoscopies between the groups (89% vs. 87%; P=0.47). However, rates of adequate bowel preparation for screening/surveillance colonoscopies were significantly higher in SMS versus control groups (93% vs. 88%; P=0.04).

CONCLUSIONS

Text message navigation for patients scheduled for colonoscopy improved the quality of colorectal cancer screening by decreasing no-show rates and increasing adequate bowel preparation rates in patients undergoing screening colonoscopy compared with usual care.

Steering of the Skyrmion Hall Angle by Gate Voltages

Magnetic skyrmions can be driven by an applied spin-polarized electron current that exerts a spin-transfer torque on the localized spins constituting the skyrmion. However, the longitudinal dynamics is plagued by the skyrmion Hall effect, which causes the skyrmions to acquire a transverse velocity component. We show how to use spin-orbit interaction to control the skyrmion Hall angle and how the interplay of spin-transfer and spin-orbit torques can lead to a complete suppression of the transverse motion. Since the spin-orbit torques can be controlled all electronically by a gate voltage, the skyrmion motion can be steered all electronically on a broad racetrack at high speed and conceptually new writing and gating operations can be realized.

The ground state phase diagram of the diluted ferromagnetic Kondo-lattice model

We investigate the existence of several (anti-)ferromagnetic phases in the diluted ferromagnetic Kondo-lattice model, i.e. ferromagnetic coupling of local moment and electron spin. To do this we use a coherent potential approximation (CPA) with a dynamical alloy analogy. For the CPA we need effective potentials, which we obtain first from a mean-field approximation. To improve this treatment we use in the next step a more appropriate moment conserving decoupling approach and compare the two methods. The different magnetic phases are modeled by defining two magnetic sub-lattices. As a result we present zero-temperature phase diagrams according to the important model parameters and different dilutions.

[Training in emergency sonography for trauma. Concept of a 1-day course program]

In the last decade prehospital focused abdominal sonography for trauma (P-FAST) could be established as a valid on-site diagnostic tool for both air and ground rescue medical services in Germany. An appropriate use of P-FAST demands a standardized training concept. Therefore a 1-day training program was developed by the working group "emergency ultrasound" in Frankfurt/Main and was introduced in 2003. The training consists of lectures on general and specific aspects of emergency ultrasound techniques with demonstrations of numerous pathological findings, intensive hands-on training with patients and volunteers, as well as simulated on-site training. After completing the P-FAST course the participants gained competency to perform prehospital emergency ultrasound with high accuracy. Strict application of the exact technique as well as appropriate integration of the adjunct into the algorithm of prehospital care are the most important prerequisites for successful use of P-FAST. From February 2003 to March 2008 540 participants were trained in P-FAST in the 1-day course.

Single-step purification and biological activity of human nerve growth factor produced from insect cells

Human nerve growth factor (NGF) was cloned and engineered for expression in a baculovirus-infected Spodoptera frugiperda (SF-9) insect cell system. Culture supernatants contained 2-3 mg/L of recombinant human NGF. The human NGF produced by this system was purified to apparent homogeneity with a single-step affinity chromatography procedure using a high-affinity monoclonal antibody originally raised against murine NGF. The purification procedure yielded 1-2 mg of pure, human NGF per liter of culture supernatant; i.e., approximately 60% recovery of the human NGF originally released into the culture medium. Although the gene transfected into the SF-9 cells coded for pro-NGF, the NGF recovered after purification was greater than 95% fully processed, mature protein. The KD for the affinity of the pure, recombinant human NGF for NGF receptor in PC12 membranes is 0.20 +/- 0.05 nM. Activation of neurite outgrowth in PC12 cells occurs with ED50 values of 85 +/- 20 pM and 9.6 +/- 1.5 pM for a 3-day primary response and a 1-day secondary response, respectively. The pure, recombinant human NGF also stimulates a significant increase in dopamine content of PC12 cells with an ED50 of 5.8 +/- 2.7 pM. These binding and biological activation properties are consistent with values observed using murine NGF purified from submaxillary glands.

[Experiences with computer-assisted x-ray diagnosis of pulmonary coin lesions (author's transl)]

Favourable results of the computer-aided diagnosis of peripheral bronchial carcinoma lead to a simplified scheme for calculation fo diagnosis, basing upon X-ray symptoms. This scheme was tested in the Zentralinstitut für Krebsforschung (ZIK) in 102 pateints and in the Forschungsinstitut für Lungenkrankheiten und Tuberkulose (FLT) in 101 patients. These patients had coin lesions of the lung with unknown diagnoses. The histological diagnoses later proved were compared with the calculated diagnoses. In ZIK there were correct diagnosis in 92.16% (in 96.53% of the carcinomas, in 44.4% of the tuberculomas and in all benign tumors), while in FLT 85.53% of the coin lesions were correctly classified (89.13% of carcinomas, 79.31% of the tuberculomas and all benign tumors). The comparison with the clinical-histological diagnoses showed a clear improvement of the accuracy by the calculated diagnoses. The method can be recommended for the basic diagnosis especially of peripheral bronchial carcinoma. It implies a reduction of the diagnostic delay, but it can not substitute the histologic investigation of the lesions.