Finding-specific display presets for computed radiography soft-copy reading.
(65/8413)
Much work has been done to optimize the display of cross-sectional modality imaging examinations for soft-copy reading (i.e., window/level tissue presets, and format presentations such as tile and stack modes, four-on-one, nine-on-one, etc). Less attention has been paid to the display of digital forms of the conventional projection x-ray. The purpose of this study is to assess the utility of providing presets for computed radiography (CR) soft-copy display, based not on the window/level settings, but on processing applied to the image optimized for visualization of specific findings, pathologies, etc (i.e., pneumothorax, tumor, tube location). It is felt that digital display of CR images based on finding-specific processing presets has the potential to: speed reading of digital projection x-ray examinations on soft copy; improve diagnostic efficacy; standardize display across examination type, clinical scenario, important key findings, and significant negatives; facilitate image comparison; and improve confidence in and acceptance of soft-copy reading. Clinical chest images are acquired using an Agfa-Gevaert (Mortsel, Belgium) ADC 70 CR scanner and Fuji (Stamford, CT) 9000 and AC2 CR scanners. Those demonstrating pertinent findings are transferred over the clinical picture archiving and communications system (PACS) network to a research image processing station (Agfa PS5000), where the optimal image-processing settings per finding, pathologic category, etc, are developed in conjunction with a thoracic radiologist, by manipulating the multiscale image contrast amplification (Agfa MUSICA) algorithm parameters. Soft-copy display of images processed with finding-specific settings are compared with the standard default image presentation for 50 cases of each category. Comparison is scored using a 5-point scale with the positive scale denoting the standard presentation is preferred over the finding-specific processing, the negative scale denoting the finding-specific processing is preferred over the standard presentation, and zero denoting no difference. Processing settings have been developed for several findings including pneumothorax and lung nodules, and clinical cases are currently being collected in preparation for formal clinical trials. Preliminary results indicate a preference for the optimized-processing presentation of images over the standard default, particularly by inexperienced radiology residents and referring clinicians. (+info)
Photostimulable storage phosphor image acquisition: evaluation of three commercially available state-of-the-art systems.
(66/8413)
Photostimulable storage phosphor (PSP) image acquisition systems have been available for several years. The technology has had the opportunity to mature; however, there has not been an independent comparison of recently marketed commercial systems. For this study, three computed radiography (CR) systems using PSP technology (Kodak CR System 400 with autoloader [Eastman Kodak, Rochester, NY], Fuji FCR AC-3CS [Fuji Medical Systems, Stamford, CT], and Agfa ADC Compact [Bayer Corp, Ridgefield Park, NJ]) were connected to an IBM RadWorks diagnostic radiology workstation (IBM Corp, White Plains, NY) and evaluated for conformance to their performance specifications using guidance provided in the most recent draft acceptance testing protocol from Task Group No. 10, American Association of Physicists in Medicine. In addition, the physical requirements (e.g., space and power) and connectivity to another manufacturer's diagnostic workstation were examined. X-ray technologist comfort with each PSP imaging system and an assessment by our supporting biomedical equipment maintenance activity of their ability to service each PSP imaging system were also considered. (+info)
Patterns of use and satisfaction with a university-based teleradiology system.
(67/8413)
The Radiology Department at the University of Arizona has been operating a teleradiology program for almost 2 years. The goal of this project was to characterize the types of cases reviewed, to assess radiologists' satisfaction with the program, and to examine case turnaround times. On average, about 50 teleradiology cases are interpreted each month. Computed tomography (CT) cases are the most common type of case, constituting 65% of the total case volume. Average turnaround time (to generate a "wet read" once a case is received) is about 1.3 hours. Image quality was rated as generally good to excellent, and the user interface as generally good. Radiologists' confidence in their diagnostic decisions is about the same as reading films in the clinical environment. The most common reason for not being able to read teleradiology images is poor image quality, followed by lack of clinical history and not enough images. (+info)
Our Healthier Nation: are general practitioners willing and able to deliver? A survey of attitudes to and involvement in health promotion and lifestyle counselling.
(68/8413)
BACKGROUND: The recent Green Paper, Our Healthier Nation, identifies professional advice on healthier living as a key component of its national contract for health. General practitioners (GPs) are ideally placed for this work. However, previous research has reported a discrepancy between patients' expectations of lifestyle advice from GPs and their receipt of such advice. AIMS: To describe GPs' current attitudes to and involvement in health promotion and lifestyle counselling, and to track changes in these areas over recent years. METHOD: A postal questionnaire survey of a random sample of 430 GPs, one per practice, from all general practices in Leicestershire, Derbyshire, and Nottinghamshire. GPs who had not responded after two weeks received a reminder telephone call plus two follow-up questionnaires. RESULTS: Four hundred and eleven GPs were eligible for the survey, which yielded a response rate of 68% (n = 279). GPs reported spending an average 16% of practice time on prevention and 79% reported educating patients about lifestyle risk 'most' or 'all of the time'. Solo GPs spent more time on prevention than GPs from group practices. Most enquiries and interventions related to smoking behaviour. GPs felt most effective in changing patients' use of prescription drugs, and the largest reported difference between current and potential effectiveness in helping patient change lifestyle behaviour, after information and training, related to reducing alcohol consumption. CONCLUSIONS: Despite an increasing workload, GPs remain positive about health promotion and lifestyle counselling. Over the past 10 years, there has been an increase in routine enquiries about lifestyle behaviour, but confidence about effectiveness in helping patients changes lifestyle behaviour remains low. More training and support concerning lifestyle intervention is required by GPs in order for them to contribute effectively to the Government's health promotion programme. (+info)
Shifting care: GP opinions of hospital at home.
(69/8413)
Hospital at home (HaH) has become an increasingly popular model of care over the past few years. However, there is little evidence to suggest that this is a superior form of care when compared with standard inpatient care in terms of cost, satisfaction, or clinical outcomes. Despite concerns that these schemes increase general practitioner (GP) workload, there is also no published evidence on the effect of HaH on GPs. As part of a broader study, a survey was undertaken of all GPs in an inner London health authority for their views of HaH. Overall, GPs felt that such schemes increased their workload, but GPs who had used HaH were more strongly in favour of these schemes for a range of conditions. (+info)
The 'heartsink' patient revisited. The Welsh Philosophy And General Practice discussion Group.
(70/8413)
The term 'heartsink patient' is now part of the vocabulary of general practice. But what and where is the heartsink? How should the phenomenon be studied? What are the implications of differing interpretations for general practice? The heartsink patient presents personal, social, and soteriological (pertaining to salvation) problems in physical terms. This poses a fundamental challenge to the philosophical foundations of general practice. Emphasizing a biomedical role justifies questioning the legitimacy of 'heartsinks' as patients. Alternatively, general practice should reassert its acceptance of suffering, whatever its origin and presentation. This would justify accommodating a far greater range of problems than simply those explained by biomedicine alone, and make general practice soteriological to the core. (+info)
The case of the missing clinical preventive services systems.
(71/8413)
OBJECTIVE: To examine the presence and comprehensiveness of organized processes and systems in a sample of primary care clinics shown to have high variation in rates of providing preventive services. DESIGN: Survey study. SETTING: 44 primary care clinics recruited for a scientific trial of a quality improvement intervention to improve preventive services. PARTICIPANTS: 647 clinicians and nurses. MEASUREMENTS: The presence of 10 organized prevention processes for eight adult preventive services as reported by those clinicians and nurses on a detailed written survey. RESULTS: In more than 50% of clinics, 7 of the 10 prevention processes were reported to be absent for all eight services. Only the follow-up process was commonly present; this was also the only process that was usually present for most applicable services. CONCLUSIONS: The paucity of recognizable organized processes to support the systematic delivery of adult preventive services in clinics with highly varying rates of providing these services supports the idea that lack of systems may be an important source of the variability and low rates. Most of the existing processes are fragmented and do not function across multiple preventive services. (+info)
Nationwide implementation of guided supermarket tours in The Netherlands: a dissemination study.
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The purpose of this study was to assess adoption, implementation and maintenance of a guided supermarket tour program of nutrition education by Dutch Public Health Services (PHSs), and the factors associated with program dissemination. A first questionnaire was sent to all 60 PHSs, and measured program adoption, perceived program attributes, and characteristics of the adopting organization and person. A second questionnaire was only sent to adopting PHSs, and measured extent and success of implementation, intentions to continue the program, and characteristics of the main implementing person. Of the 59 PHSs who responded, 30 adopted the program and 17 implemented it sufficiently. Perceived program complexity, social influence within the PHS toward program participation and existence of a separate health education department were predictors of adoption. Perceived program complexity was also a predictor of extent of implementation. The number of health educators within each PHS was a predictor of sufficient implementation. It was concluded that adoption and implementation of the program was reasonable, considering the limited dissemination strategy. Dissemination might have been more successful if the program had been less complex and required less effort, if positive social influence had been generated, and if specific attention had been given to PHSs without a separate health education department. (+info)