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Improving CT Safety

Improving CT Safety

CT is a powerful diagnostic technology, but it is also associated with risks. Ionizing radiation can damage cells and act as a weak carcinogen. The challenge is to find the optimal x-ray dose for each CT exam. “About 80 million CTs are performed each year in the United States,” says John M. Boone, PhD. “The higher the dose, the better the images, but we also want the lowest possible dose so that patients are protected from unnecessary radiation exposure. The key is to find the balance between acceptable image quality and acceptable doses.” New Strategies The Journal of the American College of Radiology (JACR) recently devoted an entire issue to CT safety. Dr. Boone and other specialists from the University of California, Davis contributed three studies to the special issue. In one of the JACR papers, the need to improve dose calculations was discussed. Manufacturers use phantoms along with instruments to measure radiation, but different companies use phantoms of different sizes, making comparisons problematic in some cases. To prevent these problems, a new metric, the size-specific dose estimate (SSDE), is recommended. “SSDEs can provide a better way to estimate patient doses and can help compare scanners from different companies,” says Dr. Boone. SSDEs may also address the need to more accurately estimate CT doses from a range of patient sizes, especially in pediatric patients. The second JACR paper addressed the challenges of optimizing different CT machines. Automatic exposure protocols must be set up, but this can vary doses based on tissue thickness. “Transferring these settings between machines can be difficult and time consuming,” Dr. Boone says. To overcome this...

Attack of The Scribes

The emergence of the electronic medical record (EMR) has spawned a new occupation—the scribe. A scribe is someone who accompanies a physician and documents the interchange between the doctor and patient. This enables the doctor to focus on the patient instead of wasting time navigating through the EMR, which has become a tool for hospital finance departments instead of a way for doctors to communicate. Scribes need not have medical backgrounds and may be drawn from the ranks of high school graduates, college students, and medical students. Salaries range from $8 to $16 per hour. Emergency departments currently are most likely to employ scribes, but they have also been hired in clinic or office settings. Is there any proof that scribes really improve productivity or satisfaction of either doctors or patients? A PubMed search using the term “scribe” yielded only 25 papers, most of which were low quality studies from emergency departments suggesting that scribe use indeed did improve productivity and physician satisfaction without impacting patient satisfaction negatively. However one paper, published in Academic Emergency Medicine, concluded the following: This retrospective data analysis suggests that at our institution, ED scribes are associated with an increase of 2.4 billed relative value units per hour, which is primarily gained from the additional 0.8 patients per hour who are seen, but not with changes in turnaround time to discharge. Some residency programs are considering using scribes to ease the burden of charting done by residents, but to date, no studies on the use of scribes on inpatient or resident teaching services have been published. Here are some concerns with the use of...
ICAAC 2014

ICAAC 2014

New research is being presented at ICAAC 2014, the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy, from September 5 to 9 in Washington, DC.   Meeting Highlights Big Benefits With Antibiotic Stewardship Programs Finding Antibiotic-Resistant Bacteria Clinical Education Key to Procalcitonin Testing Trends in P. aeruginosa Septicemia Recurrent CDI: A Look at Outcomes   News From ICAAC 2014 Coinfection less likely among children with pneumonia serotypes Ebola Response: Slowed by a ‘Perfect Storm’ of Setbacks Researchers propose new strategies to combat antimicrobial resistance In-house PCR had greater sensitivity than commercial test kits for detecting intestinal protozoa Hospitalization rates increased for patients with HCV, diabetes Antimicrobial dosing adjusted for weight led to cost savings Lab-developed, commercial assays performed comparably in norovirus detection Clinical outcomes did not differ between children with, without C. difficile Swiss MSM had vague awareness of HCV treatments, modes of transmission Antifungal’s Lower Side Effects Hold Promise Depression Linked to Postop Infection Diabetic Foot Infections Fall — Not! Short TB Regimens Disappoint Moxifloxacin Struggles Against Current TB Drugs: REMox Trial Quadruple Dosing of Doripenem Safe in Patients With CF Early targeted antibiotics improved outcomes in S. aureus bloodstream infections Combination drugs in the pipeline offer increased convenience, fewer toxicities for patients with HIV SAPPHIRE-I, II trials demonstrate minimal serious AE in HCV Vancomycin May Protect Against C. Diff Recurrence One Dose of Flu Drug Shortens Fever Single-step NAAT algorithm improved C. difficile detection Efficacy of triple therapy varied among Israeli patients with HCV Peramivir safe, effective in treating influenza symptoms Ebola in Spotlight   More From ICAAC 2014 Registration Hotel Rates & Map Schedule-at-a-Glance General Information Online...
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