To evaluate the characteristics of needle artifacts and the accuracy of needle insertion using a 1.2 Tesla open magnetic resonance imaging (MRI) system in a phantom.

First, the apparent width of the needle on the MRI and the needle tip position error of 16- and 18-gauge MRI-compatible introducer needles and a 17-gauge cryoneedle were examined with different needle angles (0°, 30°, 45°, 60°, and 90°) to the main magnetic field (B0), sequence types (balanced steady-state acquisition with rewound gradient echo [BASG] and T2-weighted fast spin echo [FSE] sequence), and frequency encoding directions. Second, the accuracy of needle insertion was evaluated after 10 MRI fluoroscopy-guided insertions in a phantom.

The apparent needle widths was larger when the angle of the needle axis relative to B0 was larger. The needles appeared larger on BASG than on T2-weighted FSE images, with the largest apparent widths of 16-, 17-, and 18-gauge needles of 14.3, 11.6, and 11.0mm, respectively. The apparent needle tip position was always more distal than the actual position on BASG images, with the largest longitudinal error of 4.0mm. selleck compound Meanwhile, the 16- and 18-gauge needle tips appeared more proximal on T2-weighted FSE images with right-to-left frequency encoding direction. The mean accuracy of MRI fluoroscopy-guided needle insertion was 3.1mm.

These experiments clarify the characteristics of needle artifacts in a 1.2 Tesla open MRI. With this system, the MRI fluoroscopy-guided needle insertion demonstrated an acceptable accuracy for clinical use.

These experiments clarify the characteristics of needle artifacts in a 1.2 Tesla open MRI. With this system, the MRI fluoroscopy-guided needle insertion demonstrated an acceptable accuracy for clinical use.

To investigate the impact of pharmaceutical care programs for the management of contraindicated drug-drug interactions (DDIs) in direct-acting antivirals (DAAs) therapy.

A prospective observational study was performed at Dalin Tzu Chi Hospital between January 2018 and December 2019. Pharmacists screened DDIs for all hepatitis C patients before DAA therapy. The study outcome included the frequency of contraindicated DDIs, acceptance rate, and cost avoidance of the pharmaceutical care program.

A total of 1053 patients were enrolled in the study, with a mean age of 67.1±11.9 years. Most patients received therapy with sofosbuvir/ledipasvir (37.1%; n=391), elbasvir/grazoprevir (23.8%; n=251), or glecaprevir/pibrentasvir (21.1%; n=222). A total of 796 (75.6%) patients received at least one co-medication, with the average number of co-medications being 5.2 per patient (SD 4.4/patient). In total, 1356 DDIs were identified, with the average DDIs per patient of 1.3 (SD 1.7). For patients with contraindicated DDIs (2%, n=102), statins and amiodarone were the most common co-medications. Physicians often accepted pharmacists’ recommendations (acceptance rate of 72.5%) or withheld co-medication to avoid severe adverse drug events (ADEs). The estimated cost avoidance of preventable ADEs was USD 14,033 for contraindicated DDIs with pharmaceutical care programs.

The implementation of pharmaceutical care programs in DAA therapy provides a favorable outcome and substantial cost avoidance.

The implementation of pharmaceutical care programs in DAA therapy provides a favorable outcome and substantial cost avoidance.

Purpose of this investigation was to get deeper insight into the impact of different radiation techniques and doses on cardiac implantable electric devices (CIEDs). We aimed to mimic a worst-case scenario with very high doses and external radiation being applied directly on the devices.

Radiation was applied on 21 CIEDs as photon or electron therapy with maximum dose of 150Gy in fractions of 2 -20Gy. CIEDS were put directly into the beam. Brachytherapy was applied with doses of 6Gy to a maximum of 42Gy. Check-ups took place after every fraction and one week after radiation. We calculated the estimated potential risk for the health and survival of patients as well as the risk for CIEDs’ loss of function.

28 life- or health-threatening errors occurred during photon therapy, 3/7 devices showed complete loss of function. During electron therapy, 31 potentially patient-threatening errors and 2 losses of function were detected. During brachytherapy, none of the devices showed loss of function but 8 patient-threatening errors occurred. Inadequate shock releases were mostly seen after photon and brachytherapy, random noises occurred more often during electron therapy. The earliest potentially serious error occurred during after 2Gy photon radiation and 6Gy brachytherapy. Losses of function occurred earliest at 80Gy.

The results underline the warning for precaution concerning CIED patients derived from recommendations in the literature. Our study offers new information especially about the impact of electron radiation and brachytherapy on CIEDs. Risk for the devices to for loss of telemetry or battery capacity might be negligible with normafractionated therapy.

The results underline the warning for precaution concerning CIED patients derived from recommendations in the literature. Our study offers new information especially about the impact of electron radiation and brachytherapy on CIEDs. Risk for the devices to for loss of telemetry or battery capacity might be negligible with normafractionated therapy.

The purpose of this project was to identify barriers to the use of pain prevention techniques during immunization.

A national, voluntary survey was distributed to members of the National Association of Pediatric Nurse Practitioners in June 2019.

The survey gathered information about the type of practitioner (pediatric nurse practitioner, family nurse practitioner, nurse, etc.), practice location (inpatient, primary care, specialty care, etc.), and patient population served and also included information regarding geographic location, socioeconomic status, insurance coverage, and immunization status as well as current practice information. Respondents identified the following barriers time (22.4%), availability (17.5%), lack of knowledge (17%), staff support (14.1%), cost (12.1%), lack of resources (7.4%), safety concerns (4.7%), environmental factor (3.4%), and other (1.4%).

The lack of pain prevention techniques is primarily because of availability, lack of knowledge and staff support, and cost. Proposed means to address these barriers include the development of a toolkit.