PubMed · 12319041
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W R Finger. 1994. Method choice involves many factors.. https://pubmed.ncbi.nlm.nih.gov/12319041/
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An objective assessment and comparison of computed radiography (CR) versus digital radiography (DR) and screen-film for performing upright chest examinations on outpatients is presented in terms of workflow, productivity, speed of service, and potential cost justification. Perceived ease of use and workflow of each device is collected via a technologist opinion survey. Productivity is measured as the rate of patient throughput from normalized timing studies. The overall speed of service is calculated from the time of examination ordering as stamped in the radiology information system (RIS), to the time of image availability on the picture archiving and communication system (PACS), to the time of interpretation rendered (from the RIS). A cost comparison is discussed in terms of potential productivity gains and device expenditures. Comparative results of a screen-film (analog) dedicated chest unit versus a CR reader and a DR dedicated chest unit show a higher patient throughput for the digital systems. A mean of 8.2 patients were moved through the analog chest room per hour, versus 9.2 patients per hour using the CR system and 10.7 patients per hour with the DR system. This represents a 12% increase in patient throughput for CR over screen-film; a 30% increase in patient throughput for DR over screen-film, which is statistically significant; and a 16% increase in patient throughput for DR over CR, which is not statistically significant. Measured time to image availability for interpretation is much faster for both CR and DR versus screen-film, with the mean minutes to image availability calculated as 29.2 +/- 14.3 min for screen-film, 6.7 +/- 1.5 min for CR, and 5.7 +/- 2.5 min for DR. This represents an improved time to image availability of 77% for CR over screen-film, 80% for DR over screen-film, and 15% for DR over CR. These results are statistically significant (P <.0001) for both CR over screen-film and DR over screen-film but not statistically significant for DR over CR. A comparison of the digital technology costs illustrates that the high cost of DR may not be justifiable unless a facility has a steady high patient volume to run the device at or near 100% productivity. Both CR and DR can improve workflow and productivity over analog screen-film in a PACS for delivery of projection radiography services in an outpatient environment. Cost justification for DR over CR appears to be tied predominantly to high patient volume and continuous rather than sporadic use patterns.
Anxiety disorders are prevalent and disabling and despite the fact that effective interventions are available, many people do not access effective treatment. Clinician decisions are fundamental determinants of access to this treatment. Despite this, treatment decisions have never been examined specifically in this group and are rarely examined in outpatient settings. The present study assessed 550 consecutive referrals to an anxiety disorders clinic in Sydney, Australia. Logistic regression was used to examine the predictors of decisions about treatment. Clinical patient variables (diagnosis and disability) were the strongest predictors of an offer of treatment but demographics and resource availability were also significant. Some of the same factors have been shown to influence the decision to seek treatment for anxiety. Both help-seeking behavior and treatment decision making are important determinants of access to care and both should be examined in future studies.
Simultaneous analysis of common antineoplastic agents potentially hazardous to healthcare workers is of much interest for the evaluation of the overall health risk to these workers. Such analysis could be applied to both air and surface monitoring samples to provide a broader indication of risk to combinations of these agents. It was determined that the ability to simultaneously evaluate five frequently used, potentially hazardous agents was sufficient for general evaluation of exposures to healthcare workers. The approach used to select the five agents was to obtain a list of the agents used most frequently in both a cancer hospital and an outpatient cancer treatment center, then review the list to determine which agents were potentially more hazardous to human health. From these reviews, it was decided to attempt to develop an analytical method able to detect and quantify the presence of 5-fluorouracil, ifosfamide, cyclophosphamide, doxorubicin HCl, and paclitaxel. A reverse-phase high performance liquid chromatograph (HPLC) with a Waters Symmetry C8 column and a UV wavelength of 195 nm was selected for method development. The mobile phase was 22.75 percent acetonitrile in water buffered to a pH of 6.0. The HPLC analytical method developed is able to detect all five agents of interest, and at minimum detectable concentrations of 0.5-microgram/mL for each of the five agents.