The justification of non-obstetric ultrasound referrals: A safe and effective practice

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110055
Author(s):  
Shaunna Smith ◽  
Trevor Parker ◽  
Pamela Parker
Keyword(s):  
Diagnostic Imaging ◽  
Waiting Time ◽  
Diagnostic Tests ◽  
Safety Assessment ◽  
Medical Ultrasound ◽  
Obstetric Ultrasound ◽  
Clinical Specialist ◽  
Benign Pathology ◽  
Increasing Demand ◽  
Strong Agreement

Introduction In 2015 the British Medical Ultrasound Society released a referral justification document for rejection of inappropriate ultrasound referrals to help manage increasing demand and ensure correct utilisation of diagnostic imaging tests. In our trust, referrals that were not aligned with the guidance were cancelled and returned to general practitioners, providing reasons for cancellation and advising other diagnostic tests if appropriate. Methodology: In total, 1000 cases cancelled between April and August 2019 were retrospectively audited by a team of clinical specialist sonographers. Interoperator agreement against BMUS justification guidelines and safety of this cancellation process were established. Duplicate imaging referrals, referrals made that should have been placed on management pathways or referrals cancelled by the patient directly were excluded in the safety assessment. Results There was strong agreement amongst sonographers regarding cancellations. After exclusions, 389 cases were included for review. The majority (90.5%) required no onward imaging and were therefore deemed cancelled appropriately. There were 37 patients found with pathology on subsequent imaging, two of which were found to have cancer and the remainder with benign pathology. Conclusions Overall, we found the cancellation process to be safe and the justification document easy to utilise in practice. This process has ensured a minimal waiting time for ultrasound imaging is maintained and that demand can be managed to meet the available capacity.

scholarly journals Exact and Heuristic Solutions to Minimize Total Waiting Time in the Blood Products Distribution Problem

2012 ◽  
Vol 2012 ◽  
pp. 1-25 ◽  
Author(s):  
Amir Salehipour ◽  
Mohammad Mehdi Sepehri
Keyword(s):  
Waiting Time ◽  
Medium Size ◽  
Distribution Problem ◽  
Distribution Management ◽  
Hybrid Heuristic ◽  
Blood Distribution ◽  
Medical Centers ◽  
Hybrid Heuristic Algorithm ◽  
Increasing Demand ◽  
Support Decision Making

This paper presents a novel application of operations research to support decision making in blood distribution management. The rapid and dynamic increasing demand, criticality of the product, storage, handling, and distribution requirements, and the different geographical locations of hospitals and medical centers have made blood distribution a complex and important problem. In this study, a real blood distribution problem containing 24 hospitals was tackled by the authors, and an exact approach was presented. The objective of the problem is to distribute blood and its products among hospitals and medical centers such that the total waiting time of those requiring the product is minimized. Following the exact solution, a hybrid heuristic algorithm is proposed. Computational experiments showed the optimal solutions could be obtained for medium size instances, while for larger instances the proposed hybrid heuristic is very competitive.

Mobile Application for Patients' Waiting Time Control and Management of Diagnostic Imaging Examinations

2020 ◽  
pp. 1522-1536
Author(s):  
Dimitrios Zarakovitis ◽  
Dimitrios Tsoromokos ◽  
Nikolaos Tsaloukidis ◽  
Athina A. Lazakidou
Keyword(s):  
Diagnostic Imaging ◽  
Real Time ◽  
Mobile Phones ◽  
Waiting Time ◽  
Personal Information ◽  
Time Data ◽  
Digital Maps ◽  
Gis Applications ◽  
Time Control ◽  
Control And Management

Geographic information systems (GIS) are useful informative systems for reducing the waiting time of diagnostic imaging examinations. ArcGIS software is used to develop a digital questionnaire which is used as a data collection tool. The information concerns the patients' personal information, type of examination required and medical history. Data is collected in real time and through GPS capabilities, the patients' exact coordinates are determined. GIS applications are used to create digital maps which display the average waiting time for performing imaging tests. Questionnaire data and interactive maps are uploaded to a digital platform. Through this application, it is possible to locate patients who actually need diagnostic imaging examinations in real time. Observing the location of patients on digital maps makes it easier to redirect them to the nearest health care units with the shortest waiting time. Data can also be acquired by mobile phones.

scholarly journals Knowledge, Attitudes and Practices of Pregnant Women towards Obstetric Ultrasound at Mulago Hospital: A Cross-sectional Survey

2021 ◽  
Author(s):  
Janvier Maniragena ◽  
Derrick Kasozi ◽  
Gonzaga Roy Mubuuke ◽  
Erick Jacob Murachi
Keyword(s):  
Pregnant Women ◽  
Waiting Time ◽  
Mulago Hospital ◽  
Ultrasound Scan ◽  
Obstetric Ultrasound ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Obstetric Ultrasonography ◽  
Knowledge Attitudes And Practices

Abstract Introduction: Obstetric ultrasonography in antenatal care (ANC) is globally recognized as one of the ways through which maternal mortality can be reduced. Pregnant women’s knowledge, perceptions, and attitudes are thought to influence their response towards obstetric ultrasonography. This study was conducted to assess the knowledge, attitudes, and practices of pregnant women towards obstetric sonography at Mulago hospital.Methods: This was a descriptive cross-sectional study that involved 300 pregnant women who reported for obstetric sonography at Mulago hospital in Kampala, Uganda. Consecutive sampling technique was used to recruit participants into the study. The data was collected using interviewer-administered questionnaires and was analyzed quantitatively into descriptive statistical tables, percentages and graphs using Statistical Package for Social Scientists (SPSS) version 25.0 software.Results: The study had a response rate of 100%. Most participants had good knowledge of obstetric ultrasound scan. However, there was a misconception that ultrasound has harmful effects. Generally, participants had a positive attitude but poor practices towards obstetric ultrasound scan. Long waiting time and lack of privacy were reported by most participants as leading factors that contributed to the poor practices. Conclusion: This study shows that the knowledge and attitude of pregnant women towards obstetric ultrasound in Mulago hospital were good. However, their practices were poor. The concerns that need to be addressed in order to improve their practices include patient’s privacy, waiting time and the misconception regarding the safety of ultrasound that it can cause cancer.

A Survey of the Use of Self-Acupuncture in Pain Clinics - a Safe Way to Meet Increasing Demand?

2004 ◽  
Vol 22 (3) ◽  
pp. 137-140 ◽  
Author(s):  
Michele Orpen ◽  
Gale Harvey ◽  
Jeff Millard
Keyword(s):  
Waiting Time ◽  
Patient Selection ◽  
Acupuncture Treatment ◽  
Pain Clinic ◽  
Use Of Self ◽  
Average Waiting Time ◽  
Pain Clinics ◽  
Increasing Demand ◽  
Published Research

An acupuncture service is well established within a pain clinic in Nottingham, England, and is now unable to meet the increasing demand for treatment despite recent expansion. Patients used to be offered training in self-acupuncture. This was withdrawn because of safety concerns, but is being considered again as a way of meeting the demand. There is little published research on the topic, so a survey of 42 English hospitals was conducted to establish whether acupuncture services are provided, and to discover whether others were offering training in self-acupuncture to patients. Thirty hospitals replied, 23 of which offer an acupuncture service. The average waiting time for the first acupuncture treatment was 18.5 weeks, and the average waiting time for follow up treatments was nine weeks. One hospital taught patients auricular self-acupuncture, another was planning to teach patients, and a third hospital had previously taught patients but stopped. Discussing these findings, concerns are raised about the safety of self-acupuncture, and issues about patient selection, training, information, supervision and supply of materials are reviewed. A debate on these issues would be valuable.

Objective Assessment of Pulmonary Embolism Can Be Deferred without Increased Risk.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1628-1628
Author(s):  
Sergio Siragusa ◽  
Alessandra Malato ◽  
Antonino Giarratano ◽  
Francesco Falaschi ◽  
Fernando Porro ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Diagnostic Imaging ◽  
Median Time ◽  
Diagnostic Tests ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk

Abstract Background. Management of patients with suspected Pulmonary Embolism (PE) is problematic if diagnostic imaging is not available. Pretest Clinical Probability (PCP) and D-dimer (D-d) assessment were shown to be useful to identify those high risk patients for whom empirical, protective anticoagulation is indicated (Siragusa S et al. Arch Intern Med2004;164:2477–82). Objective of the study. In consecutive patients with suspected PE, we evaluated whether PCP and D-d assessment, together with the use of low molecular weight heparins (LMWHs), allow objective appraisal of PE to be deferred for up to 72 hours. Methods. In case of deferment of diagnostic imaging for PE, patients identified at high-risk (those with high PCP and those with moderate PCP and a positive D-d), received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulants. All patients were scheduled to undergo objective tests for PE (ventilation/perfusion lung scanning or computed tomography lung scan) within 72 hours from the index visit (figure). Standard antithrombotic therapy was then administered when diagnostic tests confirmed Venous ThromboEmbolism (VTE). Results. 336 patients with suspected PE were included in this study. The prevalence of VTE was 6.1% (95% CI 2.7–9.3) in the “low-risk group” and 50.4% (95% CI 41.7–59.1) in the “high-risk group”. In total, VTE was confirmed in 76 (22.6%) of 336 patients (95% CI 18.2–27). Patients’ characteristics, median time for deferral test and for LMWH administration are listed in table 1. Events at the short-term (72 hours) and long-term follow-up are listed in table 2. None of the patients had major bleeding events during the follow-ups. Conclusions. When objective diagnostic assessment of PE is not immediately available, management of symptomatic PE patients can prove highly unsatisfactory. This study demonstrates that a simple and reproducible approach allows a safe deferral of diagnostic imaging for PE for up to 72 hours. patients’ characteristics Baseline features Low risk group (n. 211) High-risk group (n. 125) p value n.s.: not significant Age in years (range) 59.3 (22–91) 60.3 (23–91) n.s. Sex (F/M) 98/113 59/66 n.s. Time since onset of symptoms (days) 1.7 1.5 n.s. Co-morbidity and 16 (7.5) 25 (19.2) 0.03 Median time of deferral test (hours) 49.5 42.5 n.s. Median time of protective anticoagulation (hours) not applicable 35.5 not applicable Outcome of Short- and Long-term FU Categories of patients (n) Events at the short-term FU Events at the long -term FU* FU indicates follow-up; CI indicates Confidence Intervals. *This refers to patients in whom Pulmonary Embolism has been previously ruled out (n. 260). “Low-risk group” (211) 0 (0%) [95% CI 1.4] 0 (0%) [95% CI 1.4] “High-risk group” (125) 1 (0.8%) [95% CI 2.3] 3 (2.4%) [95% CI 3.2] Patients clinically suspected of PE without immediate availability of diagnostic tests Patients clinically suspected of PE without immediate availability of diagnostic tests

Epilepsy in veterinary patients: perspectives of Dutch veterinarians in first-line practice

2020 ◽  
Vol 187 (6) ◽  
pp. e44-e44
Author(s):  
Koen Maurits Santifort ◽  
Maud Hamers ◽  
Paul Mandigers
Keyword(s):  
Diagnostic Imaging ◽  
Diagnostic Tests ◽  
Postgraduate Education ◽  
Care Giver ◽  
First Line ◽  
Treatment Results ◽  
Web Based ◽  
General Aspects ◽  
Patients With Epilepsy ◽  
Insight Into

BackgroundThis study aims to investigate the perspectives of veterinarians in first-line practice on confidence and satisfaction regarding several important aspects of the description, diagnosis and treatment of canine patients with epilepsy.MethodsA web-based questionnaire was used, focussing on general aspects of canine epilepsy, diagnostic tests, treatment and communication with owners.ResultsOne hundred and two questionnaires were evaluated. No less than 73 per cent of veterinarians had performed euthanasia on one or more patients with epilepsy as the main reason. First-line veterinarians scored confidence on general aspects of epilepsy as 6 or 7 out of 10. Confidence regarding communication with owners was scored 7 or 8 out of 10.ConclusionsThis study provides insight into perspectives of Dutch veterinarians in first-line practice regarding canine epilepsy. Several results may provide reasons to adjust (pregraduate or postgraduate) education of veterinarians with regard to management of canine patients with epilepsy. Several factors (such as the importance of diagnostic imaging) may help specialists in the field communicate better with referring veterinarians so that first-line practitioners become better equipped in managing patients with epilepsy. These steps may then positively influence treatment results as well as care-giver burden for the first-line practitioner.

scholarly journals Filoviral haemorrhagic fevers: A threat to Zambia?

2012 ◽  
Vol 79 (2) ◽  
Author(s):  
Katendi Changula ◽  
A.S. Mweene
Keyword(s):  
Diagnostic Tests ◽  
Democratic Republic Of Congo ◽  
Emerging Infections ◽  
Number Of Patients ◽  
Increased Risk ◽  
Potential Reservoir ◽  
Increasing Demand ◽  
Primary Focus ◽  
And Control ◽  
Reservoir Hosts

Filoviral haemorrhagic fevers (FVHF) are caused by agents belonging to Filoviridae family, Ebola and Marburg viruses. They are amongst the most lethal pathogens known to infect humans. Incidence of FVHF outbreaks are increasing, with affected number of patients on the rise. Whilst there has been no report yet of FVHF in Zambia, its proximity to Angola and Democratic Republic of Congo, which have recorded major outbreaks, as well as the open borders, increased trade and annual migration of bats between these countries, puts Zambia at present and increased risk. Previous studies have indicated bats as potential reservoir hosts for filoviruses. An increasing population with an increasing demand for resources has forced incursion into previously uninhabited land, potentially bringing them into contact with unknown pathogens, reservoir hosts and/or amplifying hosts. The recent discovery of a novel arenavirus, Lujo, highlights the potential that every region, including Zambia, has for being the epicentre or primary focus for emerging and re-emerging infections. It is therefore imperative that surveillance for potential emerging infections, such as viral haemorrhagic fevers be instituted. In order to accomplish this surveillance, rapid detection, identification and monitoring of agents in patients and potential reservoirs is needed. International co-operation is the strategy of choice for the surveillance and fight against emerging infections. Due to the extensive area in which filoviral infections can occur, a regional approach to surveillance activities is required, with regional referral centres. There is a need to adopt shared policies for the prevention and control of infectious diseases. There is also need for optimisation of currently available tests and development of new diagnostic tests, in order to have robust, highly sensitive and specific diagnostic tests that can be used even where there are inadequate laboratories and diagnostic services.

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