Prevención de riesgo en radiología: El error y el radiólogo.
Between January and July, 2003, a single blinded matched trial was done to assess focalized biliary ultrasound (US) and MR cholangiography (MRCP) compared with ERCP or surgery as reference standard in patients with suspected biliary obstruction. Focalized US was performed 24 hrs before/after MRCP. Patients were triage according symptoms, signs and laboratory in high, intermediate and low risk for obstruction. Radiologists sonographers were divided in low and highly experienced. None of the radiologist who reported either US or MRCP was aware to the other test results. Sensitivity, Specificity, PPV and NPV, (LR) Likelihood Ratios and pre and post-test odds for positive and negative test were estimated.We analized 64 out of 76 sampled patients, the prevalence of obstruction was 37 % (24 out of 64 patients). US found biliary tree dilated in 50% and MRCP in 48% of the patients. Main cause of obstruction was common bile duct stones in (16) 25%. and tumors were the second more common cause. US shown a Sensitivity (S) 58.3% when a non experienced radiologist perform the exam, and 70% when an experienced radiologist doest it. Specificity (Sp) 82,5%, PPV 66.7% and NPV 76.7%. RMCP Shown S 95.8%, Sp 87.5%, PPV 82.1%, NPV 97.2% For common bile duct stones US shown a PPV 53.3% and NPV 83.6% on the other hand MRCP a PPV 70% and NPV 95.4%. MRCP perform better than focalized US in overall patients with high risk of obstruction (37.5%), detecting the cause of obstruction but using aditional sequences rising the examination time and costs. With a positive ultrasound and LR(+) 3.3 pretest odds rise from 0.37/37% to a post-test odds of 0.55/55% and with negative test result and LR(-) 0.49 pre-test odds 0.37/37% will decrease to post-test odds of 0.2/20%. With MRCP a positive test with LR(+) 7.7 initial pre-test odds 0.37/37.5% to post-test odds of 0.8/ 80% and with a negative test result LR(-) 0.05 pretest odds 0.37/37% will decrease to post-test odds of 0.03%.Ultrasound performed by experienced sonographers has a Specificity and NPV over 80%, and perform similar to MRCP for detecting biliary tree dilatation the best predictor of obstruction. In patients with low pre-test odds (low risk) of obstruction, to use focalized US and then MRCP, when the cause of obstruction is not diagnosed could be the more cost/ efective initial alternative in this patients. This data must be confirmed with further studies with cost/effectivenes analysis.
We have more than enough evidence pointing that effective clinical communication among specialists is not as good as we think. Undoubtedly, it is not a minor issue: it is directly related to patient outcomes. Radiologists are not excluded of these problems; they are part of clinical communication. Exams results must be delivered to referring physicians promptly and effectively. Coping with these issues, a primary consideration is to consider effective clinical communication a standard of good radiology practice included in regulatory standards developed for this purpose. Radiologist-to-radiologist communication is part of this matter and must be ruled by ethical, professional and respect considerations, specially referred to diagnostic error communication. The goals of these efforts are to accomplish properly our most important duty: good radiological care to our patients.
58tanto, conocerlos, especialmente los usados en nuestros lugares de trabajo, y saber qué parámetros debemos evaluar para un mejor informe radiológico.De las múltiples intervenciones sobre el hueso un común denominador son los elementos de osteosíntesis (OTS), aparatos mecánicos construidos principalmente de acero inoxidable, titanio o elementos biodegradables.Centraremos nuestra revisión en las fracturas del esqueleto apendicular, que es la patología ósea de mayor frecuencia. Ellas pueden ser tratadas con: a) Métodos cerrados, en los que se hace reducción cerrada, estabilización e inmovilización con yeso y menos comúnmente con aparatos de tracción. b) Métodos abiertos, en los que la reducción es quirúrgica o percutánea, y se efectúa estabilización y fijación interna con aparatos de OTS. c) Métodos externos con reducción, estabilización y uso de fijadores externos.Cada vez que es posible, la mayoría de los traumatólogos prefiere tratar con reducción cerrada, recuperación del alineamiento óseo y estabilización con aparatos de tracción o compresión externa, como valvas o yesos. En caso contrario, efectúan la fijación quirúrgica con reducción anatómica de los fragmentos y mantención con algún sistema de fijación, preservando el flujo sanguíneo al hueso y tejidos blandos, utilizando la técnica menos traumática posible para permitir una rápida cicatrización, recuperación precoz de la movilidad y función completa del miembro dañado.La concepción actual, sin embargo, es buscar la reducción más fisiológica posible y no necesariamente un alineamiento perfecto. Elementos utilizados en el tratamiento cerrado u ortopédico.Su objetivo principal es promover la formación de callo externo, estimulándolo con recuperación precoz de la actividad muscular, del movimiento articular y transmisión de carga. La fractura se reduce, estabiliza e inmoviliza mediante maniobras externas al foco, sin alteración del flujo sanguíneo. Abstract: Coping with orthopaedic hardware imaging has always been difficult for radiologists. We don't know adequately fixation devices implemented in fracture fixation, their characteristics, biomechanical principles, potential complications and how to report them properly. The following is a revision of these topics and suggestions in order to improve our skills in reporting as well. ELEMENTOS DE OSTEOSINTESIS DE USO HABITUAL EN FRACTURAS DEL ESQUELETO APENDICULAR
Recently adopted laws related to modifications in penal procedures have introduced major changes in the management of conflicts in healthcare. Changes, affecting radiology, include previous outcourt solutions, such as mandatory arbitrage and/or mediation or, if they fail, a medical malpractice lawsuit is filed, there are new ways for agreements: reparatory settlements, alternative judicial solutions, or, the last instance, a new kind of trial: public, oral, with the prosecution, defending and sentencing functions clearly divided. Changes in the scenario do not excuse us to adopt and implement actions to prevent medical error in our practices to reduce, conflicts and lawsuits. It will result in better medical attention.
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