Radiology report format preferred by requesting physicians: prospective analysis in a population of physicians at a university hospital / Qual formato de laudo radiológico é preferido pelos médicos solicitantes: análise prospectiva em uma população médica de um hospital universitário

Abstract Objective: To improve communication between attending physicians and radiologists by defining which information should be included in radiology reports and which reporting format is preferred by requesting physicians at a university hospital. Materials and Methods: Respondents were asked to choose among reports with different formats and levels of detail, related to three hypothetical cases, and questioned as to which characteristics commonly found in radiology reports are appropriate for inclusion. To assign the absolute order of preference of the different reports, the Kemeny-Young method was used. Results: Ninety-nine physicians completed the questionnaires (40.4% were resident physicians; 31.3% were preceptors of residency programs; and 28.3% were professors of medicine). For ultrasound with normal findings, ultrasound showing alterations, and computed tomography, respectively, 54%, 59%, and 53% of the respondents chose structured reports with an impression or comment. According to the respondents, the characteristics that should be included in the radiology report are the quality of the image, details of the clinical presentation, diagnostic impression, examination technique, and information about contrast administration, selected by 92%, 91%, 89%, 72%, and 68%, respectively. Other characteristics that were considered important were recommendations on follow-up and additional radiological or non-radiological investigation. Conclusion: Requesting physicians apparently prefer structured reports with a radiologist impression or comment. Information such as the quality of the examination, the contrast agent used, and suggestions regarding follow-up and additional investigation are valued.

Resumo Objetivo: Melhorar a comunicação entre médicos assistentes e radiologistas, definindo quais informações deveriam ser incluídas num relatório radiológico e qual o formato preferido dos solicitantes de um hospital universitário. Materiais e Métodos: Os participantes foram convidados a escolher a opção preferida entre relatórios com diferentes formatos e níveis de detalhamento de três casos hipotéticos e questionados se características comumente encontradas em um laudo radiológico são apropriadas ou não para inclusão. Para atribuição da ordem absoluta de preferência dos diferentes relatórios, o método Kemeny-Young foi utilizado. Resultados: Noventa e nove médicos responderam os questionários (40,4% médicos residentes, 31,3% preceptores dos programas de residência e 28,3% professores da faculdade de medicina). Laudos estruturados com impressão ou comentário foram selecionados nas situações de ultrassonografia normal por 54% dos participantes, ultrassonografia alterada por 59% e tomografia computadorizada por 53%. As informações que deveriam ser incluídas, de acordo com os solicitantes, foram qualidade da imagem (92%), detalhes do cenário clínico (91%), impressão diagnóstica (89%), técnica do exame (72%), informações sobre meio de contraste (68%). Opiniões sobre seguimento e investigação radiológica ou não radiológica se mostraram importantes. Conclusão: Relatórios estruturados com impressão ou comentário de um radiologista são prepostos. Informações como qualidade de exame, meio de contraste utilizado e sugestões de acompanhamento e investigação adicional são valorizadas pelos médicos solicitantes.

"No patient left behind": an alternative to "the War on Cancer" metaphor.

The War on Cancer began with President Nixon's National Cancer Act of 1971. Treatment-related 'collateral damage' to healthy cells and tissues that reduces quality of life is an unfortunate but inevitable consequence of the overriding imperative to "win the war." In the face of a quality of life decrement, patients are encouraged with militaristic turns-of-phrases to "soldier on," "fight it," and "never say die." Rather than this dysfunctional imagery, which relegates patients to the status of mere cogs in the ever-grinding wheel of the clinical war machine and encourages the practice of disease-centered medicine, we propose an alternate analogy/organizing principle borrowed from the realm of education: No patient left behind.

A new initiative on precision medicine.

President Obama has announced a research initiative that aims to accelerate progress toward a new era of precision medicine, with a near-term focus on cancers and a longer-term aim to generate knowledge applicable to the whole range of health and disease.

Biobanking for research in surgery: are surgeons in charge for advancing translational research or mere assistants in biomaterial and data preservation?

BACKGROUND: High-quality biospecimens of human origin with annotated clinical and procedural data are an important tool for biomedical research, not only to map physiology, pathophysiology and aetiology but also to go beyond in translational research. This has opened a new special field of research known as 'biobanking', which focuses on how to collect, store and provide these specimens and data, and which is substantially supported by national and European funding. PURPOSE: An overview on biobanking is given, with a closer look on a clinical setting, concerning a necessary distinction from clinical trials and studies as well as a comparison of prospective sample collection with secondary use of archived samples from diagnostics. Based on a summary of possible use and scientific impact of human tissue in research, it is shown how surgical expertise boosts the scientific value of specimens and data. Finally, an assessment of legal and ethical issues especially from a surgical perspective is given, followed by a model of interdisciplinary biobanking within a joint 'centre' that as synergistic structure merges essential input from surgery as well as laboratory medicine, pathology and biometry. CONCLUSION: Within the domain of biobanking, surgeons have to develop a better awareness of their role within translational research, not only on the level of medical faculties but also as nationally and internationally funded initiatives. Therefore, the authors suggest a platform for biobanking within the German association of surgeons in analogy to the existing special interest group for clinical trials.