RESUMO
OBJECTIVE: The objective of the present study is to evaluate patient understanding of radiology and radiologists and to assess patient interest in direct consultation with a radiologist. MATERIALS AND METHODS: A total of 1976 adult radiology outpatients at both a university and a nearby community hospital were surveyed. After an initial survey was administered, educational material with an attached follow-up survey was distributed to the patients. A McNemar test was used to assess the difference between patients who correctly chose the radiologist as the image interpreter before and after educational material was provided, whereas a paired t test was used to test the difference between patient levels of comfort with various image interpreters. RESULTS: Of the respondents, 84% expressed interest in meeting with a radiologist, with 43% willing to pay $0, 37% willing to pay $10-$30, and 20% willing to pay $40 or more to do so. Small percentages of respondents incorrectly identified ultrasound (10%) and MRI (45%) examinations as using radiation, whereas larger percentages of respondents correctly identified radiography (87%), CT (63%), and nuclear medicine imaging (62%) examinations as using radiation. A total of 73% of respondents (1002/1369) initially chose the radiologist as the image interpreter; this percentage improved to 81% (1109/1369) after the respondents received educational material (p < 0.0001). Both before and after educational material was provided, respondents had a statistically significantly lower mean (± SD) comfort level score (scale, 1-10) when faced with the prospect of a nurse or physician assistant interpreting their examination versus a trained physician (i.e., a radiologist) (mean score, 5.2 ± 3.27 and 9.4 ± 1.47, respectively, before education [p < 0.0001] and 5.2 ± 2.94 and 9.56 ± 1.24, respectively, after education [p < 0.0001]). CONCLUSION: The level of comfort with radiologists as image interpreters was statistically significantly higher than the level of comfort with nonradiologist interpreters, and most patients were interested in meeting with radiologists. Educational material improved patient perception and knowledge of radiology.
RESUMO
BACKGROUND: A nationwide outbreak of fungal infections was traced to injection of Exserohilum-contaminated methylprednisolone. We describe our experience with patients who developed spinal or paraspinal infection after injection of contaminated methylprednisolone. METHODS: Data were assembled from the Michigan Department of Community Health, electronic medical records, and magnetic resonance imaging (MRI) reports. RESULTS: Of 544 patients who received an epidural injection from a contaminated lot of methylprednisolone at a pain clinic in southeastern Michigan, 153 (28%) were diagnosed at our institution with probable or confirmed spinal or paraspinal fungal infection at the injection site. Forty-one patients had both meningitis and spinal or paraspinal infection, and 112 had only spinal or paraspinal infection. Magnetic resonance imaging abnormalities included abscess, phlegmon, arachnoiditis, and osteomyelitis. Surgical debridement in 116 patients revealed epidural phlegmon and epidural abscess most often. Among 26 patients with an abnormal MRI but with no increase or change in chronic pain, 19 (73%) had infection identified at surgery. Fungal infection was confirmed in 78 patients (51%) by finding hyphae in tissues, positive polymerase chain reaction, or culture. Initial therapy was voriconazole plus liposomal amphotericin B in 115 patients (75%) and voriconazole alone in 38 patients (25%). As of January 31, 2014, 20 patients remained on an azole agent. Five patients died of infection. CONCLUSIONS: We report on 153 patients who had spinal or paraspinal fungal infection at the site of epidural injection of contaminated methylprednisolone. One hundred sixteen (76%) underwent operative debridement in addition to treatment with antifungal agents.
