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Mervyn D Cohen

Publications and source records attributed to Mervyn D Cohen.

14 recordsLinked to original sources
PubMed2006

A new method of evaluating the quality of radiology reports.

RATIONALE AND OBJECTIVES: The radiology report must provide the ordering physician relevant information in an understandable format. The objectives of this study were to develop and apply a method for the grading of the quality of radiology reports and to evaluate differences based on the reader's experience. This grading method permits evaluation of compliance with the American College of Radiology communication standards. MATERIALS AND METHODS: A total of 240 intensive care unit admission chest radiograph reports were retrieved from our hospital database. These were graded for quality. Our grading system is based on the concept that a radiology report must provide information relevant to the patient's known clinical status and thus is important to the ordering clinician. The best grade for a report is IV and the minimum grade assigned is I. Results were further analyzed based on the experience of the reader. RESULTS: A total of 436 grades from the 240 reports were generated: 374/436 (86%) grades were designated a III or IV, which we deemed as satisfactory reports. The scoring of the radiology reports evaluating the position of endotracheal tubes, catheters, and enteric feeding tubes scored significantly better than definitive diagnosis as the starting point on the clinical spectrum (P < .01). The scores from all other patients starting points on the clinical spectrum, when compared with one another, were nonsignificant. Using a one-way analysis of variance, when comparing reports based on the six different levels of reader experience, first-year residents up to staff radiologists reports showed no significant difference (P = .78). CONCLUSIONS: Ideally, 100% of radiology reports should receive a grade III or IV. Our study showed that only 86% of the reports met this standard.

Analysis of Variance↗
PubMed2006

Evaluation of the quality of radiology requisitions for intensive care unit patients.

RATIONALE AND OBJECTIVES: The study aim is to evaluate the quality of radiology requisitions for plain film radiographs on intensive care unit (ICU) patients. MATERIALS AND METHODS: Radiology requisitions for 58 patients in ICU units at our children's hospital and the corresponding original orders for the study, written in patients' charts, were obtained. We reviewed each of the resident's written chart orders for completeness and then directly compared the information on the radiology requisition with the actual order written in the patient's chart by the ward resident physician. RESULTS: In 10% of cases, no "written order" was found in the patient's medical record for the imaging study. Clinical indications for the study were provided by the resident in only 71% (41/58) of cases. The resident's name was missing in the chart in eight of 58 cases (14%). The resident's name was provided in 50 cases, but was legible in only 28 of 50 cases (56%). In 84% of cases, the resident failed to provide his or her pager number. For one patient, the incorrect study was ordered. In only 73% (30/41) of cases did the ward clerk exactly copy the clinical indication that was handwritten in the chart by the resident. In 21% of cases, no resident's name was provided as the ordering resident on the radiology requisition. Inadequate or incomplete clinical information was provided in 24% of cases. CONCLUSION: Our study identifies a large number of problems in the quality of our radiology requisitions. Improving the process has been approved by our hospital as a major quality improvement project for this year.

Clinical Clerkship↗
PubMed2005

High-resolution computed tomography imaging of airway disease in infants with cystic fibrosis.

RATIONALE: The development of early lung disease in patients with cystic fibrosis (CF) remains poorly defined. OBJECTIVE: Determine whether asymptomatic infants with CF have evidence for changes in airway structure when assessed by high-resolution computed tomography, and whether airway structure correlates with airway function in this age group. METHODS: Thirteen infants with CF (8-33 mo) and 13 control infants (7-25 mo) were evaluated. Airway wall and lumen areas were measured from three 1-mm-thick cross-sectional images obtained from upper, middle, and lower lobes during a respiratory pause with the lungs inflated to an airway pressure of 20 cm H2O. Lung tissue density was measured from images obtained during a respiratory pause at FRC. Forced expiratory flows were measured by the rapid thoracic compression technique in 11 infants with CF. RESULTS: Airway wall area increased more per unit increase in airway size, whereas airway lumen area increased less per unit increase in airway size in the CF than in the control group. Among infants with CF, a greater ratio of wall to lumen area correlated with lower airway function. In addition, lung density at relaxed (passive) FRC was lower for infants with CF than for control infants (0.38 vs. 0.43 g/ml; p < 0.02). CONCLUSIONS: Our results indicate that infants with CF have thickened airway walls, narrowed airway lumens, and air trapping, when assessed by high-resolution computed tomography, and measurements of airway structure correlated with airway function.

Case-Control Studies↗
PubMed2005

Radiology clinical synopsis: a simple solution for obtaining an adequate clinical history for the accurate reporting of imaging studies on patients in intensive care units.

Lack of clinical history on radiology requisitions is a universal problem. We describe a simple Web-based system that readily provides radiology-relevant clinical history to the radiologist reading radiographs of intensive care unit (ICU) patients. Along with the relevant history, which includes primary and secondary diagnoses, disease progression and complications, the system provides the patient's name, record number and hospital location. This information is immediately available to reporting radiologists. New clinical information is immediately entered on-line by the radiologists as they are reviewing images. After patient discharge, the data are stored and immediately available if the patient is readmitted. The system has been in routine clinical use in our hospital for nearly 2 years.

Humans↗
PubMed2005

Gastric tube placement in young children.

In this study, the internal position of a nasogastric/orogastric tube was determined in 72 children, prior to an abdominal radiograph, by measuring CO2 and pH and bilirubin of tube aspirate. Fifteen of the 72 tubes (20.8%) were incorrectly placed on radiograph. Using the suggested adult cutoff of pH 5, pH of aspirate correctly predicted misplacement outside the stomach in 7/28 (25%) of children and correctly predicted correct placement in the stomach in 34 of 40 children (85%). Using the suggested adult cutoff of bilirubin > or = 5 mg/dL, bilirubin monitoring failed to identify either of two incorrectly placed tubes. In this study, using an algorithm of assuming stomach placement if the pH of aspirate is < or = 5 and obtaining an abdominal radiograph when either no aspirate is obtained or the pH is >5 would have resulted in 92% accuracy. Alternatively, obtaining an abdominal radiograph would result in nearly 100% accuracy.

Age Factors↗
PubMed2002

Agreement and reproducibility of subjective methods of measuring faculty time distribution.

RATIONALE AND OBJECTIVES: The authors performed this study to compare self-reported estimates of the time radiology members spend performing various activities between reporting methods and academic years. MATERIALS AND METHODS: For 3 consecutive academic years, the percentage of time each faculty member reported spending on clinical, teaching, research, and service and/or administrative activities was noted on each of three separate reports: a quarterly report to department administration, an annual report to university administration, and the annual review with his or her department supervisor. For each activity, the means were compared between methods and between years. RESULTS: In general, the year-to-year changes in mean percentage for each activity and method were not statistically significant (34 of 36 comparisons). Nineteen of 36 comparisons, however, showed significant differences between reporting methods for a particular activity. For example, the mean percentages obtained with the three methods from 1999 to 2000 varied from 49% to 66% (clinical), 14% to 34% (teaching), 8% to 15% (research), and 3% to 11% (service and/or administrative). CONCLUSION: Current methods used to quantify faculty time distribution yield significantly different results despite internal consistency from year to year for each method. New and clearer methods for determining faculty time distribution are needed.

Academic Medical Centers↗
PubMedDate not supplied

Fast fetal magnetic resonance imaging.

Fetal magnetic resonance imaging (MRI) can be used as a problem-solving tool when ultrasonic findings are equivocal. The role of fetal MRI has increased as obstetricians become aware of its potential and in utero therapy for anomalies becomes increasingly sophisticated. In this pictorial essay, we present a wide range of anomalies diagnosed or confirmed using MRI and discuss findings that help in the differential diagnosis.

Adult↗