[Handoffs in the intensive care unit]

BACKGROUND

Effective handoffs in the intensive care unit (ICU) are key to patient safety.

PURPOSE

This article aims to raise awareness of the significance of structured and thorough handoffs and highlights possible challenges as well as means for improvement.

MATERIALS AND METHODS

Based on the available literature, the evidence regarding handoffs in ICUs is summarized and suggestions for practical implementation are derived.

RESULTS

The quality of handoffs has an impact on patient safety. At the same time, communication in the intensive care setting is particularly challenging due to the complexity of cases, a disruptive work environment, and a multitude of inter- and intraprofessional interactions. Hierarchical team structures, deficiencies in feedback and error-management culture, (technical) language barriers in communication, as well as substantial physical and psychological stress may negatively influence the effectiveness of handoffs. Sets of interventions such as the implementation of checklists, mnemonics, and communication workshops contribute to a more structured and thorough handoff process and have the potential to significantly improve patient safety.

CONCLUSION

Effective handoffs are the cornerstone of high-quality and safe patient care but face particular challenges in ICUs. Interventional measures such as structuring handoff concepts and periodic communication trainings can help to improve handoffs and thus increase patient safety.

Are abbreviations and acronyms to describe hernia repair techniques overused and helpful? A proposal for rationalisation

Surgeons use abbreviations and acronyms frequently to describe surgical techniques. Recent advances and innovations in repair of abdominal wall hernias, have given rise to a plenitude of novel acronyms. For each small deviation of an existing technique authors have proposed a novel acronym. Since an acronym is most of times not self-explaining it is often hard to understand literature, lectures, symposia programs and discussions in social media. Regularly, we discover different acronyms used for the same procedure and sometimes the same or similar acronyms are used for different techniques. A clear and non-ambivalent description of surgical techniques in the literature is most valuable to summarize scientific evidence in systematic reviews and meta-analyses. We would like to propose a more rational use of abbreviations to describe hernia repair techniques based on the type of access, type of hernia, mesh position, type of mesh used and type of mesh fixation.

Bosniak Classification version 2019: validation and comparison to original classification in pathologically confirmed cystic masses

OBJECTIVE

To evaluate Bosniak Classification v2019 definitions in pathologically confirmed cystic renal masses.

MATERIALS AND METHODS

Seventy-three cystic (≤ 25% solid) masses with histological confirmation (57 malignant, 16 benign) imaged by CT (N = 28) or CT+MRI (N = 56) between 2009 and 2019 were independently evaluated by three blinded radiologists using Bosniak v2019 and original classifications. Discrepancies were resolved by consensus with a fourth blinded radiologist. Overall class and v2019 features were compared to pathology.

RESULTS

Inter-observer agreement was slightly improved comparing v2019 to Original Bosniak Classification (kappa = 0.26-0.47 versus 0.24-0.34 respectively). v2019 proportion of IIF and III masses (20.5% [15/73, 95% confidence interval (CI) 12.0-31.6%], 38.6% [28/73, 95% CI 27.2-50.5%]) differed from the original classification (6.8% [5/73, 95% CI 2.3-15.3%], 61.6% [45/73, 95% CI 49.5-72.8%]) with overlapping proportion of malignancy in each class. Mean septa number (7 ± 4 [range 1-10]) was not associated with malignancy (p = 0.89). Mean wall and septa thicknesses were 3 ± 3 (1-14) and 3 ± 2 (1-10) mm and higher in malignancies (p = 0.03 and 0.20 respectively). Areas under the receiver-operator-characteristic curve for wall and septa thickness were 0.66 (95% CI 0.54-0.79) and 0.61 (95% CI 0.45-0.78) with an optimal cut point of ≥ 3 mm (sensitivity 33.3%, specificity 86.7% and sensitivity 53%, specificity 73% respectively). Proportion of malignancy occurring in masses with the v2019 features "irregularity" (76.9% [10/13], 95% CI 46.2-94.9%) and "nodule" (89.7% [26/29], 95% CI 72.7-97.8%) overlapped. Angle of "nodule" (p = 0.27) was not associated with malignancy.

CONCLUSION

Bosniak v2019 definitions for wall/septa thickness and protrusions are associated with malignancy. Overall, Bosniak v2019 categorizes a higher proportion of malignant masses in Class IIF with slight improvement in inter-observer agreement.

KEY POINTS

• Considering Bosniak v2019 Class IIF cystic masses with many (≥ 4) smooth and thin septa, there was no association between the number of septa and malignancy (p = 0.89) in this study. • Increased cyst wall and septa thickness are associated with malignancy and a lower threshold of ≥ 3 mm maximized overall diagnostic accuracy compared to ≥ 4 mm threshold proposed for Bosniak v2019 Class 3. • An overlapping proportion of malignant masses is noted in Bosniak v2019 Class 3 masses with "irregularity" (76.9% [10/13], 95% CI 46.2-94.9%) compared to Bosniak v2019 Class 4 masses with "nodule" (89.7% [26/29], 95% CI 72.7-97.8%).

Harmonization of acronyms for volatile organic compound metabolites using a standardized naming system

Increased interest in volatile organic compound (VOC) exposure has led to an increased need for consistent, systematic, and informative naming of VOC metabolites. As analytical methods have expanded to include many metabolites in a single assay, the number of acronyms in use for a single metabolite has expanded in an unplanned and inconsistent manner due to a lack of guidance or group consensus. Even though the measurement of VOC metabolites is a well-established means to investigate exposure to VOCs, a formal attempt to harmonize acronyms amongst investigators has not been published. The aim of this work is to establish a system of acronym naming that provides consistency in current acronym usage and a foundation for creating acronyms for future VOC metabolites.

Normalizing acronyms and abbreviations to aid patient understanding of clinical texts: ShARe/CLEF eHealth Challenge 2013, Task 2

BACKGROUND

The ShARe/CLEF eHealth challenge lab aims to stimulate development of natural language processing and information retrieval technologies to aid patients in understanding their clinical reports. In clinical text, acronyms and abbreviations, also referenced as short forms, can be difficult for patients to understand. For one of three shared tasks in 2013 (Task 2), we generated a reference standard of clinical short forms normalized to the Unified Medical Language System. This reference standard can be used to improve patient understanding by linking to web sources with lay descriptions of annotated short forms or by substituting short forms with a more simplified, lay term.

METHODS

In this study, we evaluate 1) accuracy of participating systems' normalizing short forms compared to a majority sense baseline approach, 2) performance of participants' systems for short forms with variable majority sense distributions, and 3) report the accuracy of participating systems' normalizing shared normalized concepts between the test set and the Consumer Health Vocabulary, a vocabulary of lay medical terms.

RESULTS

The best systems submitted by the five participating teams performed with accuracies ranging from 43 to 72 %. A majority sense baseline approach achieved the second best performance. The performance of participating systems for normalizing short forms with two or more senses with low ambiguity (majority sense greater than 80 %) ranged from 52 to 78 % accuracy, with two or more senses with moderate ambiguity (majority sense between 50 and 80 %) ranged from 23 to 57 % accuracy, and with two or more senses with high ambiguity (majority sense less than 50 %) ranged from 2 to 45 % accuracy. With respect to the ShARe test set, 69 % of short form annotations contained common concept unique identifiers with the Consumer Health Vocabulary. For these 2594 possible annotations, the performance of participating systems ranged from 50 to 75 % accuracy.

CONCLUSION

Short form normalization continues to be a challenging problem. Short form normalization systems perform with moderate to reasonable accuracies. The Consumer Health Vocabulary could enrich its knowledge base with missed concept unique identifiers from the ShARe test set to further support patient understanding of unfamiliar medical terms.

Spelling-to-sound correspondences affect acronym recognition processes

A large body of research has examined the factors that affect the speed with which words are recognized in lexical decision tasks. Nothing has yet been reported concerning the important factors in differentiating acronyms (e.g., BBC, HIV, NASA) from nonwords. It appears that this task poses little problem for skilled readers, in spite of the fact that acronyms have uncommon, even illegal, spellings in English. We used regression techniques to examine the role of a number of lexical and nonlexical variables known to be important in word processing in relation to lexical decision for acronym targets. Findings indicated that acronym recognition is affected by age of acquisition and imageability. In a departure from findings in word recognition, acronym recognition was not affected by frequency. Lexical decision responses for acronyms were also affected by the relationship between spelling and sound-a pattern not usually observed in word recognition. We argue that the complexity of acronym recognition means that the process draws phonological information in addition to semantics.