Ethik der Reanimation und Entscheidungen am Lebensende

Notfall + Rettungsmedizin - Diese Ethikleitlinien des Europäischen Rats für Wiederbelebung enthalten evidenzbasierte Empfehlungen für die ethische, routinemäßige Praxis der...     

Percutaneous liver biopsy and track embolization with steel coils

Eight patients with liver disease and seriously abnormal blood coagulation underwent biopsy of the liver performed through a percutaneously introduced sheath, followed by embolization of the biopsy track with steel coils. In all cases the biopsy procedure produced profuse bleeding through the sheath. However, the bleeding ceased within a few minutes after coil insertion.     

Extracardiac vasculature in candidates for Fontan surgery: MR imaging

Magnetic resonance (MR) imaging was performed in 53 patients considered to be candidates for a modified Fontan operation to repair cardiac or extracardiac vascular anomalies. The MR studies were reviewed retrospectively, and the findings with regard to the extracardiac vascular anatomy were compared with the findings from angiography or surgery. The accuracy of MR for the correct identification of the systemic veins was 98%; for pulmonary arteries, 97%; and for pulmonary veins, 95%. For identification of pulmonary veins, MR imaging had a sensitivity of 90% and a specificity of 100%. MR provides excellent demonstration of the extracardiac vascular structures, which are of particular importance in patients being considered for a Fontan procedure.     

Radiologists and informed-consent lawsuits

A national survey on informed-consent lawsuits that resulted from studies using contrast material revealed that 123 (8%) of 1,513 radiologists surveyed or others in their groups had been involved in informed-consent lawsuits. In response to a detailed follow-up questionnaire, 67 radiologists anonymously provided additional information regarding their lawsuits, which most often involved excretory urography (37%) or angiography (38%), with death or neurologic impairment the most common patient injuries. As a result of these lawsuits, many radiologists provide more detailed information to patients. In the United States, the total number of informed-consent lawsuits, however, was small in relation to the total number of studies done using contrast material.     

Radiology department management system: technologists' costs

We developed a series of management reports to compare actual costs against expected costs for radiology departments on a more detailed level than previously available. We first developed labor standards for the most commonly employed diagnostic examinations and showed that increased patient complexity (resulting from, for example, immobility, precautions status, etc.) also increased the examination times up to 2.6-fold compared with the time required for average patients. Using labor standards and budgeted and actual volumes of average and complex patients, we calculated four types of variances: volume variance, examination mix variance, patient complexity variance, and technologist efficiency variance. Monitoring the technologist efficiency variance over time could be one key piece of information for improving departmental productivity.