How many medical requests for US, body CT, and musculoskeletal MR exams in outpatients are inadequate?

Purpose. Our aim was to evaluate how many medical requests for US, CT and MR outpatients exams are inadequate. Materials and methods. We evaluated three series of consecutive requests for outpatients exams, distinguishing firstly the adequate from the inadequate requests. The inadequate requests were classified as: A) absence of real indication; B) lacking or generic clinical query; C) absence of important information on patient\u2019s status. US requests concerned 282 patients for 300 body segments, as follows: neck (n=50); upper abdomen (n=95); lower abdomen (n=12); upper and lower abdomen (n=84); musculoskeletal (n=32); other body segments (n=27). Body CT requests concerned 280 patients for 300 body segments, as follows: chest (n=67); abdomen (n=77); musculoskeletal (n=94); other body segments (n=62). MR musculoskeletal requests concerned 138 patients for 150 body segments, as follows: knee (n=87), ankle (n=13), shoulder (n=28) , other body segments (n=22). Results. A total of 228/300 US requests (76%) were inadequate, ranging from 66% (musculoskeletal) to 86% (neck), classified as: A, 21/228 (9%); B, 130/228 (57%); C, 77/228 (34%). A total of 231/300 (77%) body CT requests were inadequate, ranging from 72% (chest) to 86% (musculoskeletal), classified as: A, 22/231(10%); B, 88/231(38%); C, 121/231(52%). A total of 124/150 (83%) MR musculoskeletal requests were inadequate, ranging from 69% (ankle) to 89% (knee), classified as: A, 12/124(10%); B, 50/124(40%); C, 62/124 (50%). No significant difference was found among the levels of inadequacy for the three techniques and among the body segments for each of the three techniques. Conclusions. The majority of the medical requests for outpatient exams has turned out to be inadequate. A large communication gap between referring physicians and radiologists must to be filled

Comunicazione, condivisione, coordinamento nell'attivit\ue0 della promozione della salute : la XII Conferenza Nazionale degli ospedali e servizi sanitari per la promozione della Salute

9 years after the previous HPH initiative in Milan, the Lombard network has been willing again to host the activities of the XIIth HPH National Conference, in the perspective of enhancing the Quality of organization and contents, to help participants acquire procedures and instruments more and more oriented to health promotion and to the awareness of a pathway whose contents are becoming part of the everyday activities of all the people concerned. The long. experience of the national HPH network is presenting this year some significant innovations: the international network, promoted by WHO, has recently adopted in its foundation act the orientation of supporting and fostering all the initiatives aiming at creating links among hospitals and other health services existing in "home territories" for the creation of a policy based on clear priorities of health promotion: This result has been obtained with the formulation of a Manual of Standards and HPH Specific Indicators to facilitate the services self-assessment. These are the reasons for the choice of the XIIth HPH National Conference theme, held in Milan last 16-18 October 2008; an event which has proved to be a further step in the cooperation to improve the Quality of health and life for people

Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines.

Cardiovascular (CV) toxicity is a potential short- or long-term complication of various anticancer therapies. Some drugs, such as anthracyclines or other biological agents, have been implicated in causing potentially irreversible clinically important cardiac dysfunction. Although targeted therapies are considered less toxic and better tolerated by patients compared with classic chemotherapy agents, rare but serious complications have been described, and longer follow-up is needed to determine the exact profile and outcomes of related cardiac side-effects. Some of these side-effects are irreversible, leading to progressive CV disease, and some others induce reversible dysfunction with no long-term cardiac damage to the patient. Assessment of the prevalence, type and severity of cardiac toxicity caused by various cancer treatments is a breakthrough topic for patient management. Guidelines for preventing, monitoring and treating cardiac side-effects are a major medical need. Efforts are needed to promote strategies for cardiac risk prevention, detection and management, avoiding unintended consequences that can impede development, regulatory approval and patient access to novel therapy. These new ESMO Clinical Practice Guidelines are the result of a multidisciplinary cardio-oncology review of current evidence with the ultimate goal of providing strict criteria-based recommendations on CV risk prevention, assessment, monitoring and management during anticancer treatment.Journal ArticlePractice GuidelineResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe