April 2007 - Division of Biology and Medicine - Brown University

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Point of View Retiree-Volunteers and the Abbreviations Study A few years ago, a friend, who was Director of Volunteers at The Miriam Hospital, kept insisting she could find something interesting and challenging for us to do there. We are long time members of the AARP, a nurse who became a homemaker when her children arrived and never went back to nursing, and a retired kindergarten/ reading teacher. Neither of us could imagine there could be anything challenging that we could do. We volunteered as a team, and were soon involved with many unusual and interesting projects. One of the projects took us to the office of Quality Management, where we met the Director and worked with her staff. As that project was winding down, she and the medical director of Quality Management explained a new study being introduced at The Miriam to raise the hospital’s awareness of JCAHO Standards. The study is referred to as the Abbreviations Study. Its purpose is to eliminate use of unsafe abbreviations that physicians and nurses have been using for years, because of serious errors that can occur when read incorrectly. We were given the list of abbreviations and shown how to go through patient medical records, looking for any of these abbreviations. On special summary sheets, made to make the job easier, we list the patient’s number, date of discharge, the type of inappropriate abbreviation used, number of times used, and by whom. The person using an unsafe abbreviation is notified by the hospital records department. We now know that physician’s signatures are a special type of hieroglyphic, so it is difficult to read them. A woman in the records department is terrific at figuring them out. The data are entered into a computer program that permits automated aggregation and reporting. The results are analyzed and acted on by the Quality Management and Medical Records staff. When our study began in mid 2005, only about a quarter of the charts reviewed were totally free of the prohibited abbreviations. However, after a year and a half of feedback and directed communications, nearly 80% of the medical records are free of inappropriate entries. In addition to finding fewer charts with inappropriate abbreviations, when found, there was a 45% per chart reduction in the use of the most frequently found unsafe abbreviation, (QD). When we began going to the Medical Records department, the staff were pleasant but seemed skeptical. Now they have come to realize that we are there to help make a difference. They have named us “The Tuesday Ladies” and we look forward to seeing and working in their department each week. In a very small way we feel we have made a contribution to The Miriam Hospital and the safety of its patients. And in a very large way we know that “AARP oldies” can make significant contributions through volunteering. – JOYCE BINYON – MAUREEN MCGARRY 132 MEDICINE & HEALTH/RHODE ISLAND
Images In Medicine Malignant Gastric Ulcer on Multidetector Row CT and Endoscopy Brian D. Midkiff, MD, MPH, Philip A. McAndrew, MD, and William W. Mayo-Smith, MD This 78-year-old Caucasian woman presented with epigastric pain for which endoscopy was performed. Direct endoscopic visualization demonstrated a suspicious, solitary ulcer of the posterior body and thickened folds of the antrum. Multidetector row CT examination of the abdomen with intravenous and low-density oral contrast material showed a gastric mass at the posterior midbody with a large central ulcer (arrow) as well as inflammatory thickening of the gastric antrum (arrowhead) and no evidence of local invasion or nodal disease. Biopsy performed at endoscopy demonstrated a low-grade marginal zone B-cell lymphoma. Lymphoma involves the stomach more frequently than any other segment of the gastrointestinal tract. Primary gastric lymphoma is usually confined to the stomach and regional nodes and is most commonly a non- Hodgkin lymphoma of B-cell origin. On cross-sectional imaging, gastric lymphoma typically presents as diffuse wall thickening. However, it may also manifest as focal disease or malignant ulceration, as seen in this case. Primary gastric lymphomas may be high-grade or lowgrade. Low-grade tumors, such as lymphoma of mucosa-associated lymphoid tissue (MALT), follow a more indolent clinical course and are associated with 5-year survival rates of up to 60%. Low-density oral contrast material and intravenous contrast material aid in visualization of the bowel mucosa at multidetector CT. In this patient, low-density oral contrast allowed superb CT characterization of the gastric mass and malignant ulcer. The CT image shown, which was obtained using a 64 detector row scanner, demonstrates findings which correlate well with the endoscopic images. The large mass, central ulcer, and antral wall thickening are well seen. When used appropriately, low-density oral contrast material aids in the CT investigation of mucosal pathology, including evaluation for depth of disease, perforation, local invasion and distant metastatic disease. REFERENCES Horton, KM, Fishman, EK. Current role of CT in imaging of the stomach. Radiographics 2003; 23:75-87. Ba-Ssaalamah A, et al. Dedicated multidetector CT of the stomach. Radiographics 2003; 23:625-44. CORRESPONDENCE Brian D. Midkiff, MD, MPH e-mail: Bmidkiff@lifespan.org Brian D. Midkiff, MD, MPH, is a radiology resident in the Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Philip A. McAndrew, MD, is an attending physician at Rhode Island Hospital, Warren Alpert Medical School of Brown University William W. Mayo-Smith, MD, is a Professor in the Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University. VOLUME 90 NO. 4 APRIL 2007 133
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April 2007 - Division of Biology and Medicine - Brown University

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