Care and feeding of a staff for filmless radiology.
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Texas Children's Hospital, a definitive care pediatric hospital located in the Texas Medical Center, has been constructing a large-scale picture archival and communications system (PACS) including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and computed radiography (CR). Developing staffing adequate to meet the demands of filmless radiology operations has been a continuous challenge. Overall guidance for the PACS effort is provided by a hospital-level PACS Committee, a department-level PACS Steering Committee, and an Operations Committee. Operational Subcommittees have been formed to address service-specific implementation, such as the Emergency Center Operations Subcommittee. These committees include membership by those affected by the change, as well as those effecting the change. Initially, personnel resources for PACS were provided through additional duties of existing imaging service personnel. As the PACS effort became more complex, full-time positions were created, including a PACS Coordinator, a PACS Analyst, and a Digital Imaging Assistant. Each position requires a job description, qualifications, and personnel development plans that are difficult to anticipate in an evolving PACS implementation. These positions have been augmented by temporary full-time assignments, position reclassifications, and cross-training of other imaging personnel. Imaging personnel are assisted by other hospital personnel from Biomedical Engineering and Information Services. Ultimately, the PACS staff grows to include all those who must operate the PACS equipment in the normal course of their duties. The effectiveness of the PACS staff is limited by their level of their expertise. This report discusses our methods to obtain training from outside our institution and to develop, conduct, and document standardized in-house training. We describe some of the products of this work, including policies and procedures, clinical competency criteria, PACS inservice topics, and an informal PACS newsletter. As the PACS system software and hardware changes, and as our implementation grows, these products must to be revised and training must be repeated. (+info)
How patient outcomes are reported in drug advertisements.
(10/2178)
OBJECTIVE: To examine how changes in outcomes are reported in drug advertisements in medical journals. QUALITY OF EVIDENCE: Advertisements from a convenience sample of 38 issues of Canadian Family Physician, Canadian Journal of Anaesthesia, Canadian Journal of Psychiatry, Canadian Medical Association Journal, and the New England Journal of Medicine. MAIN MESSAGE: Method of reporting changes in clinical outcomes (relative risk reduction [RRR], absolute risk reduction [ARR], number needed to treat [NNT]), name of product, and company marketing product were sought. In the 22 advertisements included in the analysis, 11 reported results as RRRs; two reported results as RRRs, but readers could calculate ARRs or NNTs from figures given in the advertisement; and nine gave no measure of results, but readers could calculate RRRs, ARRs, or NNTs from figures given. CONCLUSIONS: Most companies report changes in outcomes as RRRs, and this bias could influence the way physicians prescribe. Changes to the rules governing journal advertising and increased emphasis on critical appraisal skills would help mitigate this bias. (+info)
A bit of history.
(11/2178)
Reviews of scientific literature began to appear in the 17th century. Journals dedicated to them soon followed, leading eventually to this one, which emerged in the 1930s as Bacteriological Reviews; it adapted to the many changes in our fluid discipline, evolving into the present, much broader Microbiology and Molecular Biology Reviews. (+info)
A paean to Microbiology and Molecular Biology Reviews.
(12/2178)
This article celebrates the accomplishments of Microbiology and Molecular Biology Reviews from its early days to the present time. The importance of this journal in the professional lives of microbiologists is emphasized, and examples of outstanding reviews are presented. (+info)
Comparison of basic methods in clinical studies and in vitro tissue and cell culture studies reported in three anaesthesia journals.
(13/2178)
Tissue and cell culture (in vitro) studies reported in the 1997 issues of the British Journal of Anaesthesia, Anesthesia and Analgesia, and Anesthesiology were compared with groups of clinical studies selected at random from the same issues. Comparisons were of some basic aspects of study design and reporting that might lead to bias. The aspects examined were sample size, randomization and reporting of exclusions and withdrawals. Two groups of 53 articles were compared: sample size was smaller in in vitro than in clinical studies (median 6 vs 19); randomization was reported in five in vitro studies and in 37 studies; and failures were reported in two in vitro studies and in 43 clinical studies. This hinders interpretation of reported tissue and cell culture studies. Where possible, tissue and cell culture studies should be conducted, reported and assessed for publication to standards equivalent to those for clinical studies. (+info)
Misuse of correlation and regression in three medical journals.
(14/2178)
Errors relating to the use of the correlation coefficient and bivariate linear regression are often to be found in medical publications. This paper reports a literature search to define the problems. All the papers and letters published in the British Medical Journal, The Lancet and the New England Journal of Medicine during 1997 were screened for examples. Fifteen categories of errors were identified of which eight were important or common. These included: failure to define clearly the relevant sample number; the display of potentially misleading scatterplots; attachment of unwarranted importance to significance levels; and the omission of confidence intervals for correlation coefficients and around regression lines. (+info)
Where do UK health services researchers publish their findings?
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Health services research has emerged as the third vital requirement for understanding and improving health care, alongside basic science and clinical research. This has coincided with more stringent management of research, in particular by funding bodies. The latter are seeking to use bibliographic databases to aid the monitoring of the output of their investments. The principal source of data in the UK is the Research Outputs Database (ROD) set up by the Wellcome Trust primarily to monitor basic and clinical research. Health services researchers' output is difficult to monitor in view of the large number and wide variety of journals in which they publish. In addition, nearly half the journals (representing 35% of the articles) are not currently covered by the ROD. Funding bodies will underestimate the quantity of health services researchers' output unless they take these findings into account. (+info)
The impact of functional analysis methodology on treatment choice for self-injurious and aggressive behavior.
(16/2178)
Self-injurious behavior (SIB) and aggression have been the concern of researchers because of the serious impact these behaviors have on individuals' lives. Despite the plethora of research on the treatment of SIB and aggressive behavior, the reported findings have been inconsistent regarding the effectiveness of reinforcement-based versus punishment-based procedures. We conducted a literature review to determine whether a trend could be detected in researchers' selection of reinforcement-based procedures versus punishment-based procedures, particularly since the introduction of functional analysis to behavioral assessment. The data are consistent with predictions made in the past regarding the potential impact of functional analysis methodology. Specifically, the findings indicate that, once maintaining variables for problem behavior are identified, experimenters tend to choose reinforcement-based procedures rather than punishment-based procedures as treatment for both SIB and aggressive behavior. Results indicated an increased interest in studies on the treatment of SIB and aggressive behavior, particularly since 1988. (+info)