Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice

Background Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. Methods In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. Results A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Conclusion Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital

Comparison of outcome and characteristics between 6343 COVID-19 patients and 2256 other community-acquired viral pneumonia patients admitted to Dutch ICUs

Purpose: Describe the differences in characteristics and outcomes between COVID-19 and other viral pneumonia patients admitted to Dutch ICUs. Materials and methods: Data from the National-Intensive-Care-Evaluation-registry of COVID-19 patients admitted between February 15th and January 1th 2021 and other viral pneumonia patients admitted between January 1st 2017 and January 1st 2020 were used. Patients' characteristics, the unadjusted, and adjusted in-hospital mortality were compared. Results: 6343 COVID-19 and 2256 other viral pneumonia patients from 79 ICUs were included. The COVID-19 patients included more male (71.3 vs 49.8%), had a higher Body-Mass-Index (28.1 vs 25.5), less comorbidities (42.2 vs 72.7%), and a prolonged hospital length of stay (19 vs 9 days). The COVID-19 patients had a significantly higher crude in-hospital mortality rate (Odds ratio (OR) = 1.80), after adjustment for patient characteristics and ICU occupancy rate the OR was respectively 3.62 and 3.58. Conclusion: Higher mortality among COVID-19 patients could not be explained by patient characteristics and higher ICU occupancy rates, indicating that COVID-19 is more severe compared to other viral pneumonia. Our findings confirm earlier warnings of a high need of ICU capacity and high mortality rates among relatively healthy COVID-19 patients as this may lead to a higher mental workload for the staff. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)

Hartree-Fock-Slater LCAO calculation of the Mossbauer parameters of some antimony compounds

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Chronic alpha-1-adrenergic blockade increases sympathoneural but not adrenomedullary activity in patients with essential hypertension

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Adrenomedullary secretion of epinephrine is increased in mild essential hypertension

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Intravenous instrumentation alters the autonomic state in humans

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Differential effects of low- and high-intensity lower body negative pressure on noradrenaline and adrenaline kinetics in humans

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Teleradiology in general practice in Ameland:A cost-benefit analysis

DoelHet berekenen van de kosten en de baten van de introductie van teleradiologie in een huisartsenpraktijk op Ameland vanuit 3 perspectieven: a) de huisarts (financier); b) patiënten; c) ziektekostenverzekeraars.OpzetBeschrijvend, kosten-batenanalyse.MethodeOver het jaar 2009, 1,5 jaar na de introductie van een teleradiologiefaciliteit in een huisartsenpraktijk op Ameland, werden de bedrijfseconomische kosten, de bespaarde reiskosten en reistijd van de patiënten, en de teleradiologiekosten voor de ziektekostenverzekeraar vergeleken met de kosten die gemaakt zouden zijn zonder gebruik van teleradiologie.ResultatenIn 2009 zijn in de huisartsenpraktijk 426 röntgenonderzoeken uitgevoerd, waarvan 241 voor met trauma’s en 185 voor andere klachten. Met een vergoeding van €100 per onderzoek tijdens kantooruren (€200 in de avond- en weekenddienst) bedroegen de baten voor de huisarts (financier) €46.698 en de kosten €45.710. Dit leverde een batig saldo op van bijna €980. Patiënten besparen omgerekend €111.068 aan reistijd en -kosten. Ziektekostenverzekeraars zijn minimaal €89.265 goedkoper uit voor diagnose en behandeling.ConclusieDe introductie van teleradiologie in een huisartsenpraktijk op Ameland leidt tot aanzienlijke kostenbesparingen voor zowel patiënten als ziektekostenverzekeraars. In de toekomst kan deze manier van diagnostiek bedrijven uitgebreid worden, vooral in gebieden op grote afstand van het ziekenhuis, en kan een gedeelte van de diagnostiek en daarnaast ook behandeling in de eerstelijns gezondheidszorg ondergebracht worden tegen lagere kosten

Neurohumoral antecedents of vasodepressor reactions

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