Contribution of goal-directed ultrasonography to clinical decision-making for emergency physicians.

OBJECTIVE: To determine the contribution of goal-directed right upper quadrant (RUQ) ultrasonography (US) on real-time decision-making of attending emergency physicians by evaluating their level of certainty for admission, surgery, medical treatment, additional laboratory and radiological investigations and discharge. METHODS: The study was conducted at an urban university tertiary care emergency department with an annual census of 60,000 adult patients. Patients with acute non-traumatic RUQ pain presenting to the emergency department during the 8-month study period were enrolled into the study. Primary outcome measures were level of certainty for admission to the hospital, emergency surgery, medical treatment, additional laboratory and radiological analyses and discharge from the emergency department. RESULTS: There was a significant difference between the pre-US and post-US certainty of the decision to perform additional diagnostic studies (56 vs 72, p = 0.01) but not in the other outcomes (treatment, admission, surgery and discharge). After categorising the physicians' decisions into low, intermediate and high, US had an effect on all primary outcomes and on all categories. This effect was most evident in the moderate category where the physicians were undecided for all primary outcomes. CONCLUSION: US performed by emergency department physicians affects the certainty of their decisions in patients presenting with RUQ pain. This effect is more evident on the decision to perform additional diagnostic studies and in patients about whom physicians are undecided.

Remote sensing and GIS integration for land cover analysis, a case study: Bozcaada Island.

In this study, remote sensing and geographic information system (GIS) techniques were used in order to accomplish land cover change of Bozcaada Island, Turkey, by using multitemporal Landsat Thematic Mapper data. Digital image processing techniques were conducted for the processes of image enhancement, manipulation, registration and classification for land cover change analysis. The land cover changes between two different dates were visualized and analyzed by using Geographic Information System techniques. The results showed that remotely sensed data and GIS are effective and powerful tools for carrying out changes on land cover of the island and monitoring of its impact on the environment.