The document discusses shared decision making (SDM) in clinical encounters at Mayo Clinic. It describes the work of the Knowledge and Evaluation Research (KER) Unit, which designs and evaluates decision aids to facilitate SDM between clinicians and patients. Decision aids provide unbiased information on healthcare options and help patients consider what matters most to them. Studies show decision aids improve patient knowledge and involvement without increasing consultation time. The KER Unit has created over 20 decision aids covering various medical topics. Their goal is to create meaningful conversations centered around patient needs and values to improve healthcare outcomes and experience.
2014 0217 the experience of light for health and wellbeingcamainc
The document summarizes how light can influence health and well-being based on evidence from research. It discusses non-visual effects of light such as improving alertness, regulating circadian rhythms, reducing pain, enhancing sleep, and mood. Design features like independent lighting controls, intuitive interfaces, and nature-like lighting experiences are presented as ways to achieve health benefits. Studies showing positive patient outcomes related to better views of nature from rooms and cyclical "daylight" lighting are referenced. The focus is on an evidence-based approach to incorporating light into design and applications to improve patient, family and staff experiences as well as clinical outcomes.
2014 0503-2 sound and silence national council of acoustical consultantscamainc
The document summarizes research on noise levels in hospitals and their effects. It finds that hospital background noise often exceeds recommended levels, with common sources being staff voices, alarms, equipment. This noise disrupts patient sleep, increases stress, hinders communication and lowers satisfaction. High noise levels can also cause nurse burnout and medical errors. Design interventions discussed include creating a quiet culture, eliminating noise sources, using private patient rooms, and adding sound absorbing materials.
Feedback from referring physicians: a novel approach to improving reporting p...Trimed Media Group
This document describes a novel approach to radiology report peer review that incorporates structured feedback from referring physicians. Five referring physicians reviewed 48 randomly selected radiology reports and provided feedback via a short questionnaire. The feedback identified issues with reports such as lack of recommendations (35.4% of reports), unclear language (31.2% needed direct physician communication), and lack of clinical context. Incorporating referring physician feedback could help identify systemic reporting issues missed by radiologist-only peer review and lead to improved reporting practices. Future work includes developing an online system for structured referring physician feedback integrated into the EMR.
Technology Assessment, Outcomes Research and Economic Analysesevadew1
This document discusses technology assessment, outcomes research, and economic analyses in healthcare. It provides background on rising healthcare costs in the US and outlines a hierarchy for assessing new medical technologies from technical efficacy to patient and societal outcomes. Randomized controlled trials are described as the gold standard but limitations are noted. Alternative study designs like modeling and assessing intermediate outcomes are proposed when RCTs are not feasible. The document uses CT for appendicitis as an example to work through initial steps in outcomes research. It also discusses limitations and alternative outcomes like assessing the therapeutic value of diagnostic tests.
Detection of depression_in_patients_with_low.4wilsondjfirst
This study aimed to identify current practices for detecting and managing depression in patients with low vision among eye health professionals and rehabilitation workers. A survey of 94 such professionals found that fewer than 40% attempted to identify depression in patients. Rehabilitation workers were more likely than eye health professionals to do so. Those who tried to identify depression reported greater confidence and fewer perceived barriers. The resources and management strategies available varied between settings, with rehabilitation agencies having the most support available. Overall, no consistent strategy for depression management was identified. The study concludes that training is needed to improve skills for addressing depression in patients with low vision.
This document discusses technology assessment, outcomes research, and economic analyses in healthcare. It provides background on rising healthcare costs in the US without clear improvements in health outcomes compared to other countries. The rationale for assessing new technologies and their impact is described. Key aspects of technology assessment are outlined, including technical efficacy, diagnostic accuracy, diagnostic impact, therapeutic impact, patient outcomes, and societal outcomes. Challenges with randomized controlled trials in assessing technologies are reviewed. The National Lung Screening Trial is presented as an example. Finally, computed tomography for appendicitis is analyzed as a hypothetical example of how modeling could be used to assess a technology when a randomized trial may not be feasible.
The document discusses shared decision making (SDM) in clinical encounters at Mayo Clinic. It describes the work of the Knowledge and Evaluation Research (KER) Unit, which designs and evaluates decision aids to facilitate SDM between clinicians and patients. Decision aids provide unbiased information on healthcare options and help patients consider what matters most to them. Studies show decision aids improve patient knowledge and involvement without increasing consultation time. The KER Unit has created over 20 decision aids covering various medical topics. Their goal is to create meaningful conversations centered around patient needs and values to improve healthcare outcomes and experience.
2014 0217 the experience of light for health and wellbeingcamainc
The document summarizes how light can influence health and well-being based on evidence from research. It discusses non-visual effects of light such as improving alertness, regulating circadian rhythms, reducing pain, enhancing sleep, and mood. Design features like independent lighting controls, intuitive interfaces, and nature-like lighting experiences are presented as ways to achieve health benefits. Studies showing positive patient outcomes related to better views of nature from rooms and cyclical "daylight" lighting are referenced. The focus is on an evidence-based approach to incorporating light into design and applications to improve patient, family and staff experiences as well as clinical outcomes.
2014 0503-2 sound and silence national council of acoustical consultantscamainc
The document summarizes research on noise levels in hospitals and their effects. It finds that hospital background noise often exceeds recommended levels, with common sources being staff voices, alarms, equipment. This noise disrupts patient sleep, increases stress, hinders communication and lowers satisfaction. High noise levels can also cause nurse burnout and medical errors. Design interventions discussed include creating a quiet culture, eliminating noise sources, using private patient rooms, and adding sound absorbing materials.
Feedback from referring physicians: a novel approach to improving reporting p...Trimed Media Group
This document describes a novel approach to radiology report peer review that incorporates structured feedback from referring physicians. Five referring physicians reviewed 48 randomly selected radiology reports and provided feedback via a short questionnaire. The feedback identified issues with reports such as lack of recommendations (35.4% of reports), unclear language (31.2% needed direct physician communication), and lack of clinical context. Incorporating referring physician feedback could help identify systemic reporting issues missed by radiologist-only peer review and lead to improved reporting practices. Future work includes developing an online system for structured referring physician feedback integrated into the EMR.
Technology Assessment, Outcomes Research and Economic Analysesevadew1
This document discusses technology assessment, outcomes research, and economic analyses in healthcare. It provides background on rising healthcare costs in the US and outlines a hierarchy for assessing new medical technologies from technical efficacy to patient and societal outcomes. Randomized controlled trials are described as the gold standard but limitations are noted. Alternative study designs like modeling and assessing intermediate outcomes are proposed when RCTs are not feasible. The document uses CT for appendicitis as an example to work through initial steps in outcomes research. It also discusses limitations and alternative outcomes like assessing the therapeutic value of diagnostic tests.
Detection of depression_in_patients_with_low.4wilsondjfirst
This study aimed to identify current practices for detecting and managing depression in patients with low vision among eye health professionals and rehabilitation workers. A survey of 94 such professionals found that fewer than 40% attempted to identify depression in patients. Rehabilitation workers were more likely than eye health professionals to do so. Those who tried to identify depression reported greater confidence and fewer perceived barriers. The resources and management strategies available varied between settings, with rehabilitation agencies having the most support available. Overall, no consistent strategy for depression management was identified. The study concludes that training is needed to improve skills for addressing depression in patients with low vision.
This document discusses technology assessment, outcomes research, and economic analyses in healthcare. It provides background on rising healthcare costs in the US without clear improvements in health outcomes compared to other countries. The rationale for assessing new technologies and their impact is described. Key aspects of technology assessment are outlined, including technical efficacy, diagnostic accuracy, diagnostic impact, therapeutic impact, patient outcomes, and societal outcomes. Challenges with randomized controlled trials in assessing technologies are reviewed. The National Lung Screening Trial is presented as an example. Finally, computed tomography for appendicitis is analyzed as a hypothetical example of how modeling could be used to assess a technology when a randomized trial may not be feasible.
What We're Working On Now: Getting the "System" to be a Real System for Heart...3GDR
The document discusses the efforts of Partners HealthCare to create an integrated system for managing heart failure patients. It outlines several components of the heart failure program including enrollment numbers in remote monitoring programs over time, readmission outcomes, and an overview of the heart failure population within Partners. It also discusses challenges in patient identification, engagement, determining the most effective care delivery approach, managing patients efficiently across different care settings and providers, and integrating different systems and communications channels.
The document outlines findings from a study on rural physician retention in Michigan, which found that factors like professional satisfaction, competent medical staff, and safety of the community were most important for retention. It also provides a guide and tools for rural hospitals and clinics to develop formal retention plans to regularly check in with physicians and ensure their needs are being met to keep them in the community long-term.
The RSNA Image Share Network: Initial 12 Month Results from the UCSF Pilot SiteTrimed Media Group
This study evaluated the implementation and preliminary results of a pilot program testing the RSNA Image Share Network, a cloud-based personal health record allowing patients to access and share medical images. After modifying recruitment methods to enroll patients during their imaging appointments, enrollment increased significantly. Patient and physician surveys found high satisfaction rates and a belief in the benefits of electronic personal health records. However, some patients reported issues with the online access process. Continued evaluation is needed to assess impacts on healthcare costs and utilization.
This document discusses the importance of collaborative care and care coordination for healthcare delivery systems. It notes that solo practice is no longer a sustainable business model and that fee-for-service payments have limitations. The document provides evidence that care coordination can reduce costs through fewer hospital admissions and readmissions without worse health outcomes. It also shows that patients experience a lack of communication and information sharing between their different doctors. To improve care coordination, mobile access to patient data and collaborative workflows are seen as critical, as mobile devices are increasingly how physicians access information. The right devices and secure mobile computing are needed to enable these new care coordination models.
This document summarizes a presentation on medication-assisted treatments for substance use disorders. It discusses the use of medications to treat tobacco, alcohol, and opioid addiction. For tobacco, varenicline is recommended to reduce cravings and prevent relapse. For alcohol, disulfiram, naltrexone, and acamprosate are FDA-approved medications to prevent relapse. Characteristics and considerations for each medication are provided. The benefits of screening and brief interventions in primary care settings are also summarized.
This document provides an overview of focused ultrasound technology. It discusses how focused ultrasound is a non-invasive therapeutic technology that can be used as an alternative or adjunct to surgery, radiation therapy, and drug delivery to treat conditions like tumors, metastatic cancer, Parkinson's disease, and back pain. It explains that focused ultrasound uses intersecting beams of ultrasound focused with precision to target and treat tissue while avoiding damage to surrounding areas. The document outlines the various effects it can have on tissue and discusses its applications and development. It positions focused ultrasound as a technology that could improve quality of life for millions of patients worldwide.
Diagnostic reference levels (DRLs) provide guidance on radiation doses for typical diagnostic examinations, acting as a trigger for optimizing practices when doses are consistently exceeded. DRLs are usually set at the 75th percentile of dose distributions and can be national or local. When local doses exceed the DRL, facilities should investigate factors like equipment, technique, and case mix and identify measures to reduce doses prior to restarting audits. DRLs aim to balance radiation dose and diagnostic image quality without compromising diagnoses.
Increasing Communications Success by Thinking Differentlycrosbymarketing
This document discusses evidence-based behavior change principles that can be applied to communications and marketing. It summarizes research showing that traditional economic theories that view people as rational are inaccurate, and that unconscious behaviors drive most decisions. It then outlines several principles supported by research, including: leveraging loss aversion over potential gains, using social norms to show popular behaviors, "chunking" large tasks, employing reciprocity, focusing on current rather than future events, and using these principles in marketing contexts like healthcare and government initiatives. The document argues for an approach grounded in behavioral science instead of only providing information.
1. This study aimed to empower sub-district administration organizations (SDAOs) in Thailand to become health promoting organizations.
2. After implementing health promotion activities and training, SDAOM members had higher knowledge, attitudes, and enabling factors toward health promotion.
3. Many new health promotion activities emerged, health promotion plans and policies were established, and community participation increased.
Factors Associated with ART Non-adherence in Rural Achham, Nepal Bibhusan Basnet
This study evaluated factors associated with non-adherence to antiretroviral therapy (ART) among 105 HIV patients in rural Nepal. The results showed an 85.7% adherence rate based on patient reporting. Key factors associated with non-adherence included family obligations from field work (p<0.0001), long travel times to clinics (p=0.0219), depressed mood (p=0.0112), and socio-cultural stigma (p=0.006). Overall, patients had low rates of medication side effects and opportunistic infections, and high family support for HIV status. The study identifies challenges with ART access and adherence in remote rural settings.
YCN Breast Educational Meeting 2015-NICE Breast Cancer Quality Standards- E A...Jay Naik
Background to the the NICE Breast Cancer Quality Standards, desinged as simple measures to ensure delivery of quality care. Regional audit data for 3 Trusts presented comparing and contrasting performance against selected audit data.
Results from a collaborative survey designed to measure the infertility patient attitudes and usage of complementary and alternative medicine including acupuncture, yoga, massage and medicinal herbs.
Medipex innovation awards 2015 press releaseScott Miller
The document summarizes the winners of the eleventh annual Medipex NHS Innovation Awards and Showcase. Seven teams were awarded across five categories for their innovative projects that improve patient care and make NHS services more efficient. The winners included mobile apps to improve doctor training feedback and patient communication, and initiatives to deliver intravenous treatments and orthotics at home. The awards recognize pioneering ideas developed collaboratively between NHS staff, universities, charities, and businesses.
The document discusses ideal diagnostics and the importance of confirmatory diagnosis through appropriate investigations. It emphasizes the need for a team effort between the diagnostician and therapeutician to arrive at a final diagnosis. A variety of diagnostic investigations across different specialties like radiology, laboratory tests, cardiology, neurology, ENT, and others are mentioned as being important for evaluating different body systems and arriving at the correct diagnosis to guide treatment and management. The focus is on selecting the right investigations, properly requesting and interpreting diagnostic reports and images, and determining the appropriate next steps in management.
This document provides guidelines for patient management and ordering films for dental radiography. It describes general guidelines such as explaining procedures to patients, answering questions, and complimenting patients. It also covers special situations like gagging, children, anatomical variations, and medical conditions. Selection criteria including dental history, clinical exam findings, professional judgment, and symptomatic teeth are used to determine what radiographs are needed. Examples are provided to demonstrate applying the criteria to sample patient cases.
This document discusses basic concepts in radiology. It emphasizes that one view alone is not sufficient, and that patterns seen on images provide clues. Radiologists must be sure to look at all available views, know what they are looking for based on clinical information, and understand the limitations of different imaging tests. Seeing the whole picture and considering what each test can and cannot show is important for accurate diagnosis.
This document provides an introduction to basic radiology concepts for non-radiologists. It summarizes key information about chest x-rays including positioning, exposure quality indicators, and anatomy. Common chest x-ray findings are described such as cardiomegaly, effusions, masses, and lung diseases. CT and MRI imaging concepts are briefly introduced. Common brain pathologies detectable on scans like hemorrhages, infarcts, and disc issues are listed. The document aims to familiarize non-specialists with radiology fundamentals and basic image interpretations.
This radiology lecture covers diagnostic imaging modalities including radiation-based modalities like x-rays, CT, and nuclear medicine, as well as non-radiation modalities like ultrasound and MRI. It discusses evaluating technical adequacy, systematic approaches to reading common radiographs like chest x-rays, and the normal anatomy visualized on images. Assessment includes a written exam and attendance/participation are graded. Students are responsible for 100% attendance and active learning.
The Painful Adult Shoulder: evidence based history, exam and approachthegraymatters
This document provides an overview of a lecture on evaluating and diagnosing shoulder pain. It discusses taking a history, performing a physical exam including range of motion and provocative tests, and reviewing evidence on the diagnostic accuracy of the exam. Imaging guidelines and options like MRI, ultrasound and X-rays are presented. Common shoulder conditions like impingement, rotator cuff injuries, and adhesive capsulitis are reviewed in terms of symptoms, exam findings, imaging and treatment.
What We're Working On Now: Getting the "System" to be a Real System for Heart...3GDR
The document discusses the efforts of Partners HealthCare to create an integrated system for managing heart failure patients. It outlines several components of the heart failure program including enrollment numbers in remote monitoring programs over time, readmission outcomes, and an overview of the heart failure population within Partners. It also discusses challenges in patient identification, engagement, determining the most effective care delivery approach, managing patients efficiently across different care settings and providers, and integrating different systems and communications channels.
The document outlines findings from a study on rural physician retention in Michigan, which found that factors like professional satisfaction, competent medical staff, and safety of the community were most important for retention. It also provides a guide and tools for rural hospitals and clinics to develop formal retention plans to regularly check in with physicians and ensure their needs are being met to keep them in the community long-term.
The RSNA Image Share Network: Initial 12 Month Results from the UCSF Pilot SiteTrimed Media Group
This study evaluated the implementation and preliminary results of a pilot program testing the RSNA Image Share Network, a cloud-based personal health record allowing patients to access and share medical images. After modifying recruitment methods to enroll patients during their imaging appointments, enrollment increased significantly. Patient and physician surveys found high satisfaction rates and a belief in the benefits of electronic personal health records. However, some patients reported issues with the online access process. Continued evaluation is needed to assess impacts on healthcare costs and utilization.
This document discusses the importance of collaborative care and care coordination for healthcare delivery systems. It notes that solo practice is no longer a sustainable business model and that fee-for-service payments have limitations. The document provides evidence that care coordination can reduce costs through fewer hospital admissions and readmissions without worse health outcomes. It also shows that patients experience a lack of communication and information sharing between their different doctors. To improve care coordination, mobile access to patient data and collaborative workflows are seen as critical, as mobile devices are increasingly how physicians access information. The right devices and secure mobile computing are needed to enable these new care coordination models.
This document summarizes a presentation on medication-assisted treatments for substance use disorders. It discusses the use of medications to treat tobacco, alcohol, and opioid addiction. For tobacco, varenicline is recommended to reduce cravings and prevent relapse. For alcohol, disulfiram, naltrexone, and acamprosate are FDA-approved medications to prevent relapse. Characteristics and considerations for each medication are provided. The benefits of screening and brief interventions in primary care settings are also summarized.
This document provides an overview of focused ultrasound technology. It discusses how focused ultrasound is a non-invasive therapeutic technology that can be used as an alternative or adjunct to surgery, radiation therapy, and drug delivery to treat conditions like tumors, metastatic cancer, Parkinson's disease, and back pain. It explains that focused ultrasound uses intersecting beams of ultrasound focused with precision to target and treat tissue while avoiding damage to surrounding areas. The document outlines the various effects it can have on tissue and discusses its applications and development. It positions focused ultrasound as a technology that could improve quality of life for millions of patients worldwide.
Diagnostic reference levels (DRLs) provide guidance on radiation doses for typical diagnostic examinations, acting as a trigger for optimizing practices when doses are consistently exceeded. DRLs are usually set at the 75th percentile of dose distributions and can be national or local. When local doses exceed the DRL, facilities should investigate factors like equipment, technique, and case mix and identify measures to reduce doses prior to restarting audits. DRLs aim to balance radiation dose and diagnostic image quality without compromising diagnoses.
Increasing Communications Success by Thinking Differentlycrosbymarketing
This document discusses evidence-based behavior change principles that can be applied to communications and marketing. It summarizes research showing that traditional economic theories that view people as rational are inaccurate, and that unconscious behaviors drive most decisions. It then outlines several principles supported by research, including: leveraging loss aversion over potential gains, using social norms to show popular behaviors, "chunking" large tasks, employing reciprocity, focusing on current rather than future events, and using these principles in marketing contexts like healthcare and government initiatives. The document argues for an approach grounded in behavioral science instead of only providing information.
1. This study aimed to empower sub-district administration organizations (SDAOs) in Thailand to become health promoting organizations.
2. After implementing health promotion activities and training, SDAOM members had higher knowledge, attitudes, and enabling factors toward health promotion.
3. Many new health promotion activities emerged, health promotion plans and policies were established, and community participation increased.
Factors Associated with ART Non-adherence in Rural Achham, Nepal Bibhusan Basnet
This study evaluated factors associated with non-adherence to antiretroviral therapy (ART) among 105 HIV patients in rural Nepal. The results showed an 85.7% adherence rate based on patient reporting. Key factors associated with non-adherence included family obligations from field work (p<0.0001), long travel times to clinics (p=0.0219), depressed mood (p=0.0112), and socio-cultural stigma (p=0.006). Overall, patients had low rates of medication side effects and opportunistic infections, and high family support for HIV status. The study identifies challenges with ART access and adherence in remote rural settings.
YCN Breast Educational Meeting 2015-NICE Breast Cancer Quality Standards- E A...Jay Naik
Background to the the NICE Breast Cancer Quality Standards, desinged as simple measures to ensure delivery of quality care. Regional audit data for 3 Trusts presented comparing and contrasting performance against selected audit data.
Results from a collaborative survey designed to measure the infertility patient attitudes and usage of complementary and alternative medicine including acupuncture, yoga, massage and medicinal herbs.
Medipex innovation awards 2015 press releaseScott Miller
The document summarizes the winners of the eleventh annual Medipex NHS Innovation Awards and Showcase. Seven teams were awarded across five categories for their innovative projects that improve patient care and make NHS services more efficient. The winners included mobile apps to improve doctor training feedback and patient communication, and initiatives to deliver intravenous treatments and orthotics at home. The awards recognize pioneering ideas developed collaboratively between NHS staff, universities, charities, and businesses.
The document discusses ideal diagnostics and the importance of confirmatory diagnosis through appropriate investigations. It emphasizes the need for a team effort between the diagnostician and therapeutician to arrive at a final diagnosis. A variety of diagnostic investigations across different specialties like radiology, laboratory tests, cardiology, neurology, ENT, and others are mentioned as being important for evaluating different body systems and arriving at the correct diagnosis to guide treatment and management. The focus is on selecting the right investigations, properly requesting and interpreting diagnostic reports and images, and determining the appropriate next steps in management.
This document provides guidelines for patient management and ordering films for dental radiography. It describes general guidelines such as explaining procedures to patients, answering questions, and complimenting patients. It also covers special situations like gagging, children, anatomical variations, and medical conditions. Selection criteria including dental history, clinical exam findings, professional judgment, and symptomatic teeth are used to determine what radiographs are needed. Examples are provided to demonstrate applying the criteria to sample patient cases.
This document discusses basic concepts in radiology. It emphasizes that one view alone is not sufficient, and that patterns seen on images provide clues. Radiologists must be sure to look at all available views, know what they are looking for based on clinical information, and understand the limitations of different imaging tests. Seeing the whole picture and considering what each test can and cannot show is important for accurate diagnosis.
This document provides an introduction to basic radiology concepts for non-radiologists. It summarizes key information about chest x-rays including positioning, exposure quality indicators, and anatomy. Common chest x-ray findings are described such as cardiomegaly, effusions, masses, and lung diseases. CT and MRI imaging concepts are briefly introduced. Common brain pathologies detectable on scans like hemorrhages, infarcts, and disc issues are listed. The document aims to familiarize non-specialists with radiology fundamentals and basic image interpretations.
This radiology lecture covers diagnostic imaging modalities including radiation-based modalities like x-rays, CT, and nuclear medicine, as well as non-radiation modalities like ultrasound and MRI. It discusses evaluating technical adequacy, systematic approaches to reading common radiographs like chest x-rays, and the normal anatomy visualized on images. Assessment includes a written exam and attendance/participation are graded. Students are responsible for 100% attendance and active learning.
The Painful Adult Shoulder: evidence based history, exam and approachthegraymatters
This document provides an overview of a lecture on evaluating and diagnosing shoulder pain. It discusses taking a history, performing a physical exam including range of motion and provocative tests, and reviewing evidence on the diagnostic accuracy of the exam. Imaging guidelines and options like MRI, ultrasound and X-rays are presented. Common shoulder conditions like impingement, rotator cuff injuries, and adhesive capsulitis are reviewed in terms of symptoms, exam findings, imaging and treatment.
This document provides an overview of radiologic technology, including:
1. It discusses the importance of quality customer service and managing patient expectations through clear communication and a professional demeanor.
2. The history of radiology and medicine are summarized, from ancient practices to modern advancements in technology and understanding of anatomy.
3. Key aspects of radiologic technology education are introduced, including developing skills in both medical imaging and caring for diverse patient needs.
Radiology is a four-year medical residency with common fellowships after. It is a basic element of medical care and frequently results in patient admission or diagnosis. The document outlines basic radiology concepts - one view is insufficient so use multiple views, patterns provide clues to diagnosis, ensure thorough image review, know what you're looking for, and understand test limitations. It provides examples of using pattern recognition and multiple views to correctly diagnose conditions like pneumonia subtypes, pneumothorax, pneumomediastinum, and fractures. It stresses using decision trees and understanding when secondary tests are needed based on initial findings and patient history.
Staging of testicular cancer
MRI: Scrotal masses that are indeterminate on US
Scintigraphy: Acute scrotal pain
MUSCULOSKELETAL SYSTEM
Plain films: Initial study for trauma, suspected fracture,
joint disease
US: Soft tissue masses, joint effusions, tendon/ligament
injuries
CT: Complex fractures, bone tumors, postoperative
evaluation
MRI: Soft tissue and bone marrow lesions, postoperative
evaluation, suspected ligament/tendon injury
Bone scan: Suspected metastasis, stress fractures
Arthrography: Internal derangements of joints
MUSCULOSKELETAL SYSTEM
Plain
This document discusses radiology and the use of x-rays. It begins with an introduction to radiology and x-rays, noting their importance as the "father of medical investigations." It then discusses anatomy as seen on radiographs and whether x-rays are enough. The document goes on to compare gross views to radiological views, noting what each can and cannot show. It highlights important figures in the development of radiology, from x-rays to CT, MRI, and ultrasound. Specific anatomical structures visible on upper and lower limb x-rays are listed. The document concludes by discussing how pathologies appear on x-rays and the importance of clinical history and knowledge when interpreting radiological images.
The document provides an overview of radiology as a field and various radiological imaging modalities. It discusses the discovery of X-rays, basic principles of X-ray imaging including density and natural contrast, and different imaging technologies such as radiography, CT, ultrasound, MRI, and their applications. Examples of clinical images from different modalities like CT, MRI, ultrasound, and angiography are also presented.
This document provides an overview of musculoskeletal radiology and imaging techniques used to evaluate the musculoskeletal system. It discusses normal skeletal anatomy and appearances on x-rays. Common radiological signs are described, such as osteoporosis, fractures, and periosteal reactions. Imaging findings of musculoskeletal disorders like osteomyelitis and tumors are also reviewed. Evaluation of fractures and dislocations with different imaging modalities is covered.
This document provides an introduction to various medical imaging modalities including X-ray, CT, mammography, MRI, PET, SPECT, and ultrasound. It discusses the principles, techniques, and indications for each modality. Key terms are defined. Images demonstrate examples of each type of imaging. The objectives are to recognize imaging study types, discuss how images are produced, list common indications, and describe imaging precaution considerations.
1. The document describes several medical cases with imaging findings and diagnoses. It discusses abnormalities seen on CT scans and x-rays indicating conditions like diffuse idiopathic skeletal hyperostosis, tuberculous spondylitis, leaking dermoid tumour, Takayasu arteritis, and advanced bronchial carcinoma.
2. Key findings mentioned include flowing osteophytes, ossification of the posterior longitudinal ligament, calcified psoas abscesses, hydronephrosis, widened mediastinum with sternotomy sutures, dissecting aneurysm of the aorta, occlusion of arteries, and diffuse mural thickening of the rectum and colon.
3. The document
This survey of radiographers in Australian hospitals investigated their participation in abnormality detection systems for trauma radiographs, their perceptions of the benefits and barriers of radiographer commenting, and their views on radiographer image interpretation services. The results found that most radiographers participated in abnormality detection for less than 20% or more than 80% of examinations. Perceived benefits included assisting patient care, but barriers included limited access to image interpretation education and low confidence. Improving access to education was seen as an enabler for greater participation in detection and commenting systems.
The document discusses shared decision making (SDM) in clinical encounters at Mayo Clinic. It describes the work of the Knowledge and Evaluation Research (KER) Unit, which designs and evaluates decision aids to facilitate SDM between clinicians and patients. Decision aids provide unbiased information on healthcare options and help patients consider what matters most to them. Studies show decision aids improve patient knowledge and involvement without increasing consultation time. The KER Unit has created over 20 decision aids covering various medical topics. Their goal is to create meaningful conversations centered around patient needs and values to improve healthcare outcomes and experience.
Digital radiography (DR) has transformed pediatric radiology by reducing radiation dose, imaging costs, and patient turnaround times compared to film-screen radiography and computed radiography. DR allows images to be acquired digitally and viewed immediately, improving workflow efficiency. Studies have shown average turnaround times for skeletal exams decreased from 12 minutes with film-screen radiography to 3 minutes with DR. Faster turnaround times with DR have improved relations between radiology and clinical services by keeping pace with busy clinics. Phoenix Children's Hospital transitioned exclusively to DR and saw these benefits firsthand with the installation of multiple DR units, including one with a dual-detector configuration.
This document outlines the objectives and agenda for a workshop on journal clubs and evidence-based medicine reviews. The workshop will teach participants how to present clinical evidence-based medicine summaries to peers, critically appraise clinical studies, and discuss how to integrate evidence-based findings into clinical practice. Participants will have opportunities to present on their own clinical scenarios and evidence searches.
Transitioning into 24/7 Teleradiology Coverage - Dr Anjali AgrawalMathew B R
What are the pitfalls you would encounter when you transition into a 24/7 Teleradiology Coverage ?
For more info on how we can help you . contact
info@telradsol.com
This document discusses interprofessional rounding teams and strategies to improve teamwork and communication. It provides background on how interprofessional healthcare teams can improve patient outcomes. Checklists, care pathways, and interprofessional education are presented as potential solutions. Checklists have been shown to reduce medical errors and mortality. Care pathways, while challenging to implement, can standardize care and reduce prescribing errors. Brief interprofessional education sessions have been found to improve collaboration attitudes and skills among professionals. Overall, the document advocates for interprofessional rounding teams and strategies to enhance communication and teamwork across disciplines.
Resident Presentations - Evidence-Based Medicine for HaematologyRobin Featherstone
This document provides information about a workshop on evidence-based medicine (EBM) for residents. The workshop objectives are to present clinical EBM summaries to peers and critically reflect on applying clinical studies to practice. The document reviews the EBM process and provides worksheets and resources for critically appraising different study designs, including randomized controlled trials, cohort and case-control studies, and systematic reviews. Key points of the critical appraisal worksheets are summarized for each study design. Logistical details are provided for the next workshop.
This document discusses multisource feedback (MSF) and its use in physician assessment and revalidation. It provides evidence from various studies that MSF can reliably and validly assess physician competencies. However, it also notes limitations in terms of its ability to consistently change physician behavior and the high costs associated with MSF programs. Overall, the document presents both sides of the debate around using MSF as an essential component of physician revalidation.
The document discusses artificial intelligence (AI) and its applications and implications for radiology. It begins by outlining the goals of understanding basic AI concepts, techniques used in radiology imaging, and the benefits, pitfalls and challenges of AI systems. It then discusses why AI is an important topic, noting the large investments being made in healthcare AI and how it will impact practices. The document reviews several uses of AI in radiology, including detecting pneumonia on chest x-rays and interpreting breast and chest CT images. It also discusses challenges of AI implementation and how radiologists can leverage AI to enhance their work while staying actively involved in patient care.
The document discusses artificial intelligence (AI) and its applications in radiology. It begins by outlining the goals of understanding basic AI concepts, techniques used in radiology imaging, and the benefits, pitfalls and challenges of AI systems. It then discusses why radiologists should understand AI due to its impact on healthcare practices and competitive advantages. The document provides examples of AI being used for tasks like segmentation, detection of pneumonia on chest x-rays, and reducing unnecessary breast biopsies. It also discusses challenges of AI like establishing ground truths for validation and ensuring speeds allow clinical use. Overall, the document argues AI can increase diagnostic certainty and improve radiologist worklife if integrated properly into clinical workflows.
This study assessed adherence to recommendations for follow-up imaging made in emergency abdominal ultrasound examinations. Of 1404 exams, recommendations were made in 329 reports (23.4%), totaling 355 recommendations. Adherence was 52.9%, defined as the recommended study being performed. Adherence was influenced by factors like ultrasound findings being abnormal versus normal, the organ system/pathology involved, and whether findings matched clinical suspicion. Addressing these factors could improve adherence and continuity of patient care.
This document summarizes evidence from a systematic review on effective interventions to improve antibiotic prescribing in primary care. The review found that interventions involving multiple components, including educational materials and meetings for physicians, were most effective at reducing total antibiotic prescribing. Delayed prescribing strategies that provide clear instructions on use were also effective. Communication skills training for physicians, with or without decision aids, reduced prescribing for respiratory tract infections. The use of near-patient tests also reduced prescribing when combined with clinical training.
Implementing psychosocial care into routine practice: making it easyCancer Institute NSW
1. This document discusses implementing a clinical pathway for screening and managing anxiety and depression in cancer patients. It outlines barriers to implementation and strategies to address them.
2. A key barrier is that screening alone does not improve outcomes; a clear clinical pathway and institutional support are needed. The pathway was developed through stakeholder consultation and specifies screening, assessment, referral, and treatment steps.
3. Barriers to implementing the pathway include lack of resources, responsibility issues, staff and patient reluctance. The proposed study will test intensive versus basic strategies to promote pathway uptake, including online training, automated screening/referral systems, and patient/staff educational resources. The goal is to improve psychosocial outcomes for cancer patients.
Involveconference2 121120053215-phpapp02Marilyn Mann
Iain Chalmers argues that a significant amount of medical research is wasted due to issues such as:
1) Low priority questions being addressed instead of what matters most to clinicians and patients.
2) Many studies being poorly designed and not learning from existing evidence.
3) Important results from studies often not being published or reported, leading to bias.
He advocates for greater public involvement in setting research agendas and priorities to better align research with patient and clinician needs and reduce waste estimated at over $85 billion per year. The James Lind Initiative seeks to address research waste and improve focus on shared uncertainties.
Iain Chalmers argues that a significant amount of medical research is wasted due to issues such as:
1) Low priority questions being addressed instead of what matters most to clinicians and patients.
2) Many studies being poorly designed and not learning from existing evidence.
3) Important results from studies often not being published or reported, leading to bias.
He advocates for greater public involvement in setting research agendas and priorities to better align research with patient and clinician needs and reduce waste estimated at over $85 billion per year. The James Lind Initiative seeks to address research waste and improve focus on shared uncertainties.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Healthcare Leadership Forum’s Evidence at the Center of Care focused on implementing IT and evidence-based medicine in every day practice. This meeting brought together clinical and IT leaders in an interactive environment where attendees learned about best practices for integrating evidence into clinical practice, enabling more efficient, high-quality healthcare delivery.
Nov. 14-15, 2013 | Chicago
Sponsored by: ClinicalKey / Elsevier
Presented by: Clinical Innovation + Technology
Telemedicine expanded access to stroke care in Oregon. A survey found 43% of respondents had access to in-person stroke care, 76% to telemedicine care, and 40% to both. Counties with high telemedicine access had lower uninsured rates and older adult populations compared to counties with low access. Telemedicine reduced the population without access to stroke care from 57% to 20%.
The statin drug market is expected to decline significantly through 2018 due to increased generic competition lowering revenues. Global statin revenues are projected to drop from $20.5 billion in 2011 to $12.2 billion in 2018, while US statin revenues will plunge from $8.4 billion in 2011 to $6 billion in 2018 following the loss of patents for major drugs. The highly competitive generic market and limited new therapies will decrease interest in the statin market.
Step up to bat and practice dictating complex cases a residents guide to effe...TriMed Media Group
Findings:
There is a normal appendix
visualized in the RLQ. The
small bowel appears normal
without evidence of
diverticulum.
The document provides guidelines for effective radiology reporting, noting that residency training focuses
Impression:
little on dictation skills. It highlights the importance of concise, clinically relevant reports that answer the
No evidence of Meckel
diverticulum. Normal exam.
clinical question. The guidelines emphasize organizing findings logically, providing a clear impression, and
focusing reports on the clinical history and diagnosis rather than just describing images.
Radiology Workflow: Recognizing Clinical & Financial Benefits of Implementing...TriMed Media Group
This document summarizes a presentation about implementing an integrated radiology information system (RIS), picture archiving and communication system (PACS), and reporting solution at Rutland Regional Medical Center. The system provides streamlined workflow from patient check-in through report delivery. It has led to improved efficiency through a unified system, faster report turnaround times, reduced transcription needs, better monitoring of metrics, and enhanced collaboration between radiologists and other physicians. The integrated system also allows for improved coding and billing processes as well as cost savings through staffing reductions.
James F. Padbury, MD and Betty R. Vohr, MD give a tour of the neonatal intensive care unit (NICU) at Women & Infants Hospital of Rhode Island. The NICU has multiple family rooms where loved ones can visit patients and staff host family events. All clinical staff carry mobile devices to communicate and receive alerts about patients. Families send thank you cards expressing gratitude to the nurses. The NICU was designed architecturally to feel like one connected space across two floors. High-definition imaging stations are available for doctors to view diagnostic images. Private patient rooms are identical to make navigation easier for staff.
Inside a Private HIE: Clinical, Economic and Operational Successes at The Was...TriMed Media Group
The Washington Health Information Network (WHIN) is a private health information exchange (HIE) that connects The Washington Hospital and physician practices affiliated with the Washington Physician Hospital Organization (WPHO). MobileMD is the backbone of WHIN. Denise Abraham, the health information exchange coordinator for The Washington Hospital, and Charles R. Vargo, executive director of the WPHO, work closely to keep this vital piece of caregiver connectivity alive. WHIN is having a positive impact on patient care and clinical practice by increasing physician knowledge and boosting efficiency by allowing physicians, nursing and key clinical staff secure access to key information such as lab and radiology reports and EKGs. The private HIE has united 13 EMRs from different vendors via interfaces to provide one data repository for enterprise access. Learn why they chose a private HIE, how it has evolved from 2006 until now and what advice they offer to other healthcare systems ready to embark on a private HIE project.
How Healthcare Reform Is Affecting Radiology, Pam KassingTriMed Media Group
How Healthcare Reform Is Affecting Radiology - Presented by: http://www.healthimaging.com - speaker: Pam Kassing, MS, Senior Director of Health Policy, American College of Radiology. Presented at the GE Virtual Conference, September 14, 2011.
Meaningful Use and Its Impact on Medical Imaging: Part 1 - Presented by http://www.healthimaging.com - invited speaker: Arun Krishnaraj, MD, MPH, Massachusetts General Hospital. Part of the GE Virtual Conference September 14, 2011.
The document discusses different approaches to meeting meaningful use (MU) criteria. It identifies some "wrong ways" like "duck and cover", doing the minimum to get through year one ("one and done"), and just focusing on the money ("take the money and run"). The author advocates a better approach of linking the criteria to seven evidence-based quality improvement projects, plus ensuring patient privacy protections and effective training and communication. While certification can be complicated, the author believes their approach can help hospitals actualize improvements in a meaningful way to qualify for MU incentives.
This document summarizes strategies for clinician adoption after an EHR go-live presented by Dr. Justin Graham. It recommends embedding HIT into organizational strategy, evolving governance from projects to operations, having realistic EHR expectations, setting virtuous workflow cycles, preparing for requests, learning informatics team management, and keeping vision and momentum. Culture change takes time and an engaged clinical leader, informatics team, and communication plan are important for adoption.
This document discusses clinical decision support (CDS), which uses clinical knowledge and patient data to improve healthcare decisions. It outlines several types of CDS interventions like drug interactions checking and standardized order sets. Successful CDS requires delivering the right information to the right person in the right format through the right channel at the right time. Organizations should use CDS strategically to achieve priorities like reducing medical errors. The document provides recommendations for implementing an effective CDS program like gaining leadership support, appointing a champion, and continually communicating the program's value.
This document provides an overview of health information exchange (HIE) in Vermont. It discusses VITL, a non-profit organization that operates the statewide HIE, connecting hospitals, practices, and other providers. It describes how HIE is integrated into Vermont's health reform efforts like the Blueprint for Health, which uses clinical data to support practices' transformation to the patient-centered medical home model and provide population health management. The document also notes some learnings around vendor challenges, interoperability issues, and ensuring HIE sustainability beyond public funding as payment models evolve.
This document discusses communication strategies for an electronic health record implementation project. It emphasizes the importance of communicating clearly and honestly with all stakeholders, including physicians, nurses, and other staff. Effective communication requires understanding different audiences, crafting individualized messages, and selecting the right messengers who are respected within each group. The overall goal of communication is to help stakeholders understand and buy into the changes required to achieve the project's objectives.
The document outlines an agenda for a CMIO Summit on June 10th, 2011. The agenda includes definitions, an overview of LIPIX including its funding and mission, explanations of health information exchange and RHIO, LIPIX's goals, participating providers, technical architecture, use cases, products/services, and strategies for engaging providers. It aims to educate on LIPIX's role in facilitating health information exchange across the region and debunk common myths about HIE.
This document discusses collaboration strategies between the Chief Medical Information Officer (CMIO) and Chief Medical Officer (CMO) at Kings County Hospital. It provides background on Kings County Hospital, which is a 650-bed academic and tertiary hospital within the New York City Health & Hospitals Corporation public hospital system. It then outlines how the CMIO and CMO roles have evolved to focus more on analytics, reporting, and using health IT to improve quality, safety, and achieve regulatory and reform goals like accountable care. Specific examples of collaborations around computerized physician order entry, clinical decision support, and reducing hospital-acquired infections are also provided.
CCHIT provides EHR certification programs including an ONC-ATCB program and their own CCHIT Certified program. They also offer an EHR Alternative Certification for Healthcare Providers (EACH) program to help providers of self-developed or customized EHRs achieve certification. The presentation covered the certification landscape, certification processes, tips for providers, and the future of EHR certification.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
PCPs speak out on rad reporting
1. Recommendations within the radiology
report: implications for the primary care
physician
Andrew J. Gunn, MD
Dushyant V. Sahani, MD
Susan E. Bennett, MD
Garry Choy, MD
3. Introduction
• Radiology reports are the primary work product of the
radiologist
• Radiology reports are the principal means by which the
findings of an examination are communicated to the
patient’s care team
• The radiology report is of particular importance to primary
care physicians in the outpatient setting, who may not
have the time or ability to consult the radiologist in person
4. Introduction
• There is considerable interest in improving radiology
reporting practices
– RSNA Reporting Initiative
– American College of Radiology (ACR) has developed
“Practice Guidelines for Communication of Diagnostic
Imaging Findings”
– Multiple survey-based reports in the literature
assessing referring physician preferences with regard
to the radiology report
5. Introduction
TECHNIQUE: Two views of the chest
• It has been suggested that the
radiologist should make HISTORY: As provided in header
recommendations within the COMPARISON: None.
report for further diagnostic
FINDINGS:
studies or treatment, if Lungs: The lungs are well-inflated and clear. There
appropriate is no focal pneumonia or pulmonary edema.
Pleura: There is no pleural effusion or pneumothorax.
Heart and Mediastinum: The cardiomediastinal silhouette is
• At our institution, we place unremarkable.
recommendations in their own Bones: The bones are unremarkable.
section within the structured
IMPRESSION: Normal examination
radiology report, which helps the
reader recognize when a RECOMMENDATION: None.
recommendation has been
Figure 1 (above). Sample structured report for a
made (Figure 1). chest radiograph which includes a separate
“recommendation” section
6. Questions
• How do primary care physicians perceive
recommendations made by radiologists?
• Do recommendations made by radiologists affect the
practices of primary care physicians?
• Does the wording or location of the recommendation
within the report change how it is perceived?
7. Materials and Methods
An on-line survey was distributed to 229 primary care
physicians at our institution through an internal listserv
(Figure 2, next slide)
9. Results
• Respondents
– 100 responses (43.6% response rate)
– Averaged 19.1 years in practice (range: 2-50 years)
– 95% order less than 20 examinations per week
10. Results
Referring Physician Satisfaction
1-5 scale
3.9
3.5
Satisfaction with reporting in general Satisfaction with recommendations
Figure 3. Mean physician satisfaction with reporting overall was 3.9 on a 1-5 scale while mean satisfaction with
radiologist recommendations was still 3.5, it was significantly less (p=0.02) than overall satisfaction
11. Results
Single Biggest Problem with Radiology Reports
Figure 4. “Too many
25%
recommendations for
8%
further diagnosis and
treatment” was
identified as the biggest
19% problem with radiology
reporting while “Not
36% enough
12% recommendations for
Too Many Recommendations for Further Diagnosis and Treatment further diagnosis and
Not Enough Recommendations for Further Diagnosis and Treatment treatment” was the third
Unclear or Non-Specific Language most commonly cited
Didn't Answer the Clinical Question problem.
Other*
Gunn AJ et al. JACR, in press
12. Results
• Referring physicians were Items Necessary in the Radiology Report
allowed to select items they
100
felt were necessary in a 90
88
radiology report 80
Number of Responses
70
60
50 43 42
40
• Figure 5 (right). Referring 30
20
physicians chose
10
“Recommendations for 0
further imaging” twice as Recommendations for
Consultation
Recommendations for
Further Imaging
Recommendations for
Treatment
much as other types of
recommendations
13. Results
Do You Feel Medico-Legally Obligated by Recommendations in a
Radiology Report?
3%
3%
Yes
No
Unsure
94%
Figure 6. 94% of primary care physicians feel medico-legally obligated by radiologist recommendations.
14. Results
Do You Feel More or Less Medico-Legally Obligated if
Do You Feel More or Less Medico-Legally Obligated if
the Recommendation has Qualifying Language?
the Recommendation is Set Apart in its Own Section
within the Report?
24%
12%
5%
2%
More Obligated
More Obligated
Less Obligated
Less Obligated 72%
No difference
No Difference
Unsure
Unsure 23%
0%
62%
Figure 7. 23% of primary care physicians feel more medico-legally obligated by the
recommendation if it’s found within its own section in the report (above left). 62% of
primary care physicians feel less medico-legally obligated by the recommendation if
qualifying language such as “if clinically indicated” is added (above right). Gunn AJ, et al
JACR, in press.
15. Results
Should a Radiologist Adjust the Recommendation Based upon
the Specialty of the Ordering Provider?
15%
6%
Yes
No
Unsure
79%
Figure 8. The majority of respondents felt that the radiologist should not change
their recommendations based on the specialty of the ordering provider.
16. Discussion
• Overall, satisfaction with both radiology reporting and
radiologist recommendations is good amongst primary
care physicians
• Primary care physicians, however, are less satisfied with
recommendations than they are with reports in general
– The reasons for this difference are unclear and likely
multi-factorial
17. Discussion
• There is wide variability of opinion amongst primary care
physicians as to the utility of radiologist recommendations
– “Too many recommendations” was the most commonly
cited problem with reports (36%)
– “Not enough recommendations” was the third most
commonly cited problem with reports (12%)
– The literature suggests this variability, however, is
shared by other physicians, even radiologists
– This is a difficult conundrum to overcome for the
radiologist
18. Discussion
• Recommendations for further imaging were the preferred
type of recommendation
– Primary care physicians do not prefer the radiologist to
suggest treatments or consultation
– Suggests that primary care physicians would rather
make those decisions themselves
19. Discussion
• Primary care physicians feel medico-legally obligated by radiologist
recommendations
• Placing the recommendation within its own section in the structured
radiology report increases this sense of obligation
– In this location, the recommendation, either intentionally or
unintentionally, has been given added significance
• Adding qualifying language to the recommendation decreases this
sense of obligation
– Qualifying language provides the primary care physician more
flexibility in clinical decision-making
20. Discussion
• Radiologist recommendations have an impact on the
practice of primary care physicians even though their
attitudes regarding these recommendations are variable
• This impact seems to be modulated by both the location
and wording of the recommendation
• Radiologists should consider these factors when making
recommendations within the report
21. Selected References
1. McLoughlin RF, So CB, Gray RR, et al. Radiology reports: How much
descriptive detail is enough? AJR 1995;165:803-6.
2. Friedman PJ. Radiology Reporting: Structure. AJR 1983;140:171-
3. Fischer HW. Better communication between the referring physician
and the radiologist (editorial). Radiology
4. ACR Practice Guidelines for Communication of Diagnostic Imaging
Findings. Revised 2010. Downloaded from www.acr.org.
5. Lawson DE, Siegel SC. A recommendation regarding
recommendations. AJR Am J Roentgenol 1997; 169:351-2.
6. Kessler HB. The contemporary radiologist: consultant or film reader?
AJR Am J Roentgenol 1997; 169:353-4.