Timely follow-up of abnormal diagnostic imaging test results in an outpatient setting: are electronic medical records achieving their potential?

BACKGROUND: Given the fragmentation of outpatient care, timely follow-up of abnormal diagnostic imaging results remains a challenge. We hypothesized that an electronic medical record (EMR) that facilitates the transmission and availability of critical imaging results through either automated notification (alerting) or direct access to the primary report would eliminate this problem. METHODS: We studied critical imaging alert notifications in the outpatient setting of a tertiary care Department of Veterans Affairs facility from November 2007 to June 2008. Tracking software determined whether the alert was acknowledged (ie, health care practitioner/provider [HCP] opened the message for viewing) within 2 weeks of transmission; acknowledged alerts were considered read. We reviewed medical records and contacted HCPs to determine timely follow-up actions (eg, ordering a follow-up test or consultation) within 4 weeks of transmission. Multivariable logistic regression models accounting for clustering effect by HCPs analyzed predictors for 2 outcomes: lack of acknowledgment and lack of timely follow-up. RESULTS: Of 123 638 studies (including radiographs, computed tomographic scans, ultrasonograms, magnetic resonance images, and mammograms), 1196 images (0.97%) generated alerts; 217 (18.1%) of these were unacknowledged. Alerts had a higher risk of being unacknowledged when the ordering HCPs were trainees (odds ratio [OR], 5.58; 95% confidence interval [CI], 2.86-10.89) and when dual-alert (\u3e1 HCP alerted) as opposed to single-alert communication was used (OR, 2.02; 95% CI, 1.22-3.36). Timely follow-up was lacking in 92 (7.7% of all alerts) and was similar for acknowledged and unacknowledged alerts (7.3% vs 9.7%; P = .22). Risk for lack of timely follow-up was higher with dual-alert communication (OR, 1.99; 95% CI, 1.06-3.48) but lower when additional verbal communication was used by the radiologist (OR, 0.12; 95% CI, 0.04-0.38). Nearly all abnormal results lacking timely follow-up at 4 weeks were eventually found to have measurable clinical impact in terms of further diagnostic testing or treatment. CONCLUSIONS: Critical imaging results may not receive timely follow-up actions even when HCPs receive and read results in an advanced, integrated electronic medical record system. A multidisciplinary approach is needed to improve patient safety in this area

In silico bioprospection analysis for identification of herbal compound targeting Clostridium difficile

655-661Clostridium difficile infection (CDI), the occurrence has been increasing in the community as well as hospital-care facilities, resulting in higher morbidity and mortality rate. C. difficile, anaerobic pathogen greatly associated with antibiotic resistance and majorly linked to the irrational antibiotic use, which accelerate the alarming situation causing endemic as well epidemic globally. It is the budding menace and one of the major sources of nosocomial infection, i.e., hospital-acquired infection. The prevailing risk to public health by the antibiotics and their resistance majorly has driven the urge for utilizing the traditional herbal medicine into a sophisticated approach as a Modern/Ayurvedic Medicinal System (AMS). The current study aims to find out the promising herbals to combat the threat caused by C. difficile by applying herbal informatics as a holistic approach. Total 44 plants were elucidated against the virulence factors of the bacterium using the systematic bioprospection approach, out of which 5 plants were optimized that may be futher validated at the preclinical level

In silico bioprospection analysis for identification of herbal compound targetingClostridium difficile

Clostridium difficile infection (CDI), the occurrence has been increasing in the community as well as hospital-care facilities, resulting in higher morbidity and mortality rate. C. difficile, anaerobic pathogen greatly associated with antibiotic resistance and majorly linked to the irrational antibiotic use, which accelerate the alarming situation causing endemic as well epidemic globally. It is the budding menace and one of the major sources of nosocomial infection, i.e., hospital-acquired infection. The prevailing risk to public health by the antibiotics and their resistance majorly has driven the urge for utilizing the traditional herbal medicine into a sophisticated approach as a Modern/Ayurvedic Medicinal System (AMS). The current study aims to find out the promising herbals to combat the threat caused by C. difficile by applying herbal informatics as a holistic approach. Total 44 plants were elucidated against the virulence factors of the bacterium using the systematic bioprospection approach, out of which 5 plants were optimized that may be futher validated at the preclinical leve

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Contrast echocardiography for right-sided heart conditions: Case reports and literature review

Contrast echocardiography is recognized to be a safe, effective technique for evaluating the endocardial border and left ventricular function in patients who have suboptimal non-contrast echocardiograms. However, its use in diagnosing right-heart conditions is less well established. Herein, we report our experience with the use of contrast echocardiography for diagnosing 3 distinct right-sided heart conditions (hypokinesis of the right ventricular free wall, severe tricuspid regurgitation, and cardiac tamponade) in patients who had suboptimal echocardiograms. Further studies should be done to validate the use of contrast echocardiography for diagnosing right-heart conditions

Contrast Echocardiography for Right-Sided Heart Conditions: Case Reports and Literature Review

Contrast echocardiography is recognized to be a safe, effective technique for evaluating the endocardial border and left ventricular function in patients who have suboptimal noncontrast echocardiograms. However, its use in diagnosing right-heart conditions is less well established. Herein, we report our experience with the use of contrast echocardiography for diagnosing 3 distinct right-sided heart conditions (hypokinesis of the right ventricular free wall, severe tricuspid regurgitation, and cardiac tamponade) in patients who had suboptimal echocardiograms. Further studies should be done to validate the use of contrast echocardiography for diagnosing right-heart conditions

Migraine and Vasodepressor Syncope in a Large Family

We evaluated a 47-year-old woman for recurrent migraine and syncope. The patient had 7 children (not examined by the authors), all of whom also experienced migraine and syncope. The patient's father, now deceased, had reportedly experienced migraine and episodes of feeling faint. All 5 of the patient's siblings reported migraine, and 4 of the 5 reported syncope. The case of our patient, which we discuss herein, suggests a genetic link between these 2 conditions, both of which include vascular dysregulation in their pathogenesis. To our knowledge, the medical literature contains no previous description of familial associations of combined migraine and syncope