Improving Radiology Report Quality by Rapidly Notifying Radiologist of Report Errors

Radiology report errors occur for many reasons including the use of pre-filled report templates, wrong-word substitution, nonsensical phrases, and missing words. Reports may also contain clinical errors that are not specific to the speech recognition including wrong laterality and gender-specific discrepancies. Our goal was to create a custom algorithm to detect potential gender and laterality mismatch errors and to notify the interpreting radiologists for rapid correction. A JavaScript algorithm was devised to flag gender and laterality mismatch errors by searching the text of the report for keywords and comparing them to parameters within the study’s HL7 metadata (i.e., procedure type, patient sex). The error detection algorithm was retrospectively applied to 82,353 reports 4 months prior to its development and then prospectively to 309,304 reports 15 months after implementation. Flagged reports were reviewed individually by two radiologists for a true gender or laterality error and to determine if the errors were ultimately corrected. There was significant improvement in the number of flagged reports (pre, 198/82,353 [0.24 %]; post, 628/309,304 [0.20 %]; P = 0.04) and reports containing confirmed gender or laterality errors (pre, 116/82,353 [0.014 %]; post, 285/309,304 [0.09 %]; P < 0.0001) after implementing our error notification system. The number of flagged reports containing an error that were ultimately corrected improved dramatically after implementing the notification system (pre, 17/116 [15 %]; post, 239/285 [84 %]; P < 0.0001). We developed a successful automated tool for detecting and notifying radiologists of potential gender and laterality errors, allowing for rapid report correction and reducing the overall rate of report errors.     

Evaluación del triaje realizado por enfermeras en el Servicio de Urgencias del Hospital Clínico Universitario «Lozano Blesa» (Zaragoza)

Objective

To evaluate nurses’ triage quality and adequacy in Saragossa's Hospital Clínico and to compare the main characteristics of “urgent” and “non-urgent” visits to the Hospital Emergency Department (HED).

Impact of revised triage to improve throughput in an ED with limited traditional fast track population

Background

Emergency department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput.

Safety assessment for octadecyl 3-(3,5-di-tert-butyl-4-hydroxyphenyl)-propionate (CAS Reg. No. 2082-79-3) from use in food contact applications

Octadecyl 3-(3,5-di-tert-butyl-4-hydroxyphenyl)propionate (CAS Reg. No. 2082-79-3), currently marketed as Irganox 1076 (I-76), is a sterically hindered phenolic antioxidant used in a variety of organic substrates, including those used in the manufacture of food contact articles. In 2012, the US Food and Drug Administration (USFDA), Office of Food Additive Safety (OFAS), initiated a post-market re-evaluation of the food contact applications of I-76. This project aimed to ensure that current dietary exposures from the use of I-76 in food contact articles are accurately captured and the safety assessment considered all relevant and available toxicological information. To accomplish these aims, the USFDA reviewed the available toxicological studies and chemistry information on food contact applications of I-76. Based on this in-depth analysis, a NOAEL of 64 mg/kg-bw/d (female rats) from a chronic rat study and a cumulative estimated dietary intake (CEDI) of 4.5 mg/p/d, was used to calculate a margin of exposure (MOE) of ∼850. We concluded that the previous and current exposure levels provide an adequate margin of safety (MOS) and remain protective of human health for the regulated uses.     

特殊使用级抗菌药物点评系统的开发与应用

目的:开发特殊使用级抗菌药物点评系统,提高特殊使用级抗菌药物的临床使用水平,降低细菌耐药率。方法:利用易语言和数据库技术,建立特殊使用级抗菌药物合理性评分表,特殊使用级抗菌药物点评系统。对2010年1-6月和2013年1-6月特殊使用级抗菌药物使用病历的越级使用情况、病原微生物送检情况、抗菌药物使用合理性(药物选择、用法用量、联合用药)、会诊单例数、平均使用金额和特殊使用级抗菌药物使用强度进行回顾性统计并分析。结果:系统实现了特殊使用级抗菌药物处方点评功能,系统应用后抗菌药物越级使用率从14.9%下降至2.3%(P=0.000);病原微生物送检率从47.3%提高至93.9%(P=0.000);抗菌药物选择合理率从88.1%上升至96.9%(P=0.000);会诊单申请率从40.2%提高至97.3%(P=0.000)。特殊使用级抗菌药物使用强度从164.3下降至84.2(P=0.042);平均使用金额从1 210.4元下降至964.1元(P=0.032)。结论:特殊使用级抗菌药物点评系统提高了特殊使用级抗菌药物管理水平,有效地降低了特殊使用级抗菌药物费用支出。     

Serotonergic dysfunction, negative mood states, and response to alcohol

BACKGROUND: Dysfunction of central serotonergic neurotransmission has been implicated in the pathogenesis and maintenance of alcoholism. Serotonergic dysfunction may be associated with three behavior patterns relevant for alcoholism: impulsive aggression, negative mood states, and a low response to alcohol intake. METHODS: We reviewed the literature on the psychopathological correlates of serotonergic dysfunction and focused on studies that assess the interaction between negative mood states and alcohol response. RESULTS: Prospective studies in nonhuman primates that underwent early separation stress found an association between a low serotonin turnover rate and the disposition to excessive alcohol intake and impulsive aggression. These findings seem to be relevant for a subgroup of alcoholics with a low serotonin turnover rate and antisocial personality traits. Cross-sectional data in humans also support a relationship between reduced serotonergic neurotransmission and aggressive behavior and indicate that the association of serotonergic dysfunction and aggression may be mediated by negative mood states. This hypothesis is in accordance with a large body of data linking anxiety and depression to serotonergic dysfunction. In human alcoholics, brain imaging has detected a reduction in serotonin transporter availability in association with depression. Serotonin transporter availability seems to be related to reduced GABA-ergic sedation and the acute response to alcohol intake, an important predictor of subsequent development of alcohol dependence. CONCLUSIONS: Several lines of evidence point to a relationship between serotonergic dysfunction, negative mood states, and excessive alcohol intake, which may be mediated in part by reduced alcohol-induced sedation.     

儿童镇静程度评估工具的研究进展

镇静程度评估可指引镇静行为,是制订患儿镇静管理方案的重要依据。该文对常用的儿童镇静评估工具的主要内容、特点、优势及局限性进行综述,并对各评估工具的基本情况及临床应用情况进行比较,以期为临床护士选择合适的评估工具,提高镇静评估准确性提供参考。