Utility of Reviewing Radiology Studies in Electronic Medical Records When Preparing Bone Mineral Density Reports.

We quantitated how often review of recent radiology studies provides information useful to the densitometrist. While preparing bone mineral density (BMD) reports on 1012 consecutive patients, radiology reports in electronic medical records (EMRs) for the previous 5 years at potentially relevant sites (lumbar spine X-rays, abdominal computed tomography (CT) scans, and so forth) were reviewed. When a study was found, it received a grade according to how relevant findings were to the BMD report: "1" for studies that were irrelevant, "2" for those that confirmed the impression formed from review of the BMD images, "3" for those that clarified the impression that was unclear after reviewing the BMD images, and "4" for those that revealed new relevant data when no abnormality was noted on review of the BMD images. A total of 562 patients (55.5%) had a radiologic study at a site of potential interest within the past 5 years. Fifty-three patients (5.2% of all patients) had a grade 4 study, 88 patients (8.7% of all patients) had a grade 3 study, and 185 patients (18.3% of all patients) had a grade 2 study. Two hundred sixty-four patients (25.8%) had a grade 2 or 3 study, and 299 (29.5%) had a grade 2-4 study. The radiographic study that was most likely to be found in patients' EMR was chest X-ray (34.7% of all patients), but it was also the one that was least likely to have any relevance to the reader; only 10.5% of the total chest X-rays were graded 2-4. The next most likely studies to be found in patients' EMR were abdominal CT scans (18.0% of all patients) and lumbar spine X-rays (14.4% of all patients), but these studies were much more likely to be useful to the reader, as 62.6% of abdominal CT scans and 78.1% of lumbar spine X-rays were graded 2-4. The likelihood of a patient having radiologic examinations in the EMR at sites potentially relevant to the BMD reader is high, but the likelihood that these clarify abnormalities noted on BMD is only moderate. Review of the EMR is unlikely to be relevant when the dual-energy X-ray absorptiometry images are normal.

Effect of Clothing on Measurement of Bone Mineral Density.

It is unknown whether allowing patients to have BMD (bone mineral density) studies acquired while wearing radiolucent clothing adlib contributes appreciably to the measurement error seen. To examine this question, a spine phantom was scanned 30 times without any clothing, while draped with a gown, and while draped with heavy winter clothing. The effect on mean BMD and on SD (standard deviation) was assessed. The effect of clothing on mean or SD of the area was not significant. The effect of clothing on mean and SD for BMD was small but significant and was around 1.6% for the mean. However, the effect on BMD precision was much more clinically important. Without clothing the spine phantom had an least significant change of 0.0077 gm/cm(2), while when introducing variability of clothing the least significant change rose as high as 0.0305 gm/cm(2). We conclude that, adding clothing to the spine phantom had a small but statistically significant effect on the mean BMD and on variance of the measurement. It is unlikely that the effect on mean BMD has any clinical significance, but the effect on the reproducibility (precision) of the result is likely clinically significant.

On the road with injury prevention--an analysis of the efficacy of a mobile injury prevention exhibit.

BACKGROUND: To assess the effectiveness of a mobile injury prevention vehicle (mobile safety street [MSS]) with a hands-on curriculum on instruction and retention of safety knowledge compared with traditional classroom safety curriculum among grade 5 elementary school children. METHODS: Grade 5 students (n = 1,692) were asked to participate in the study as either the intervention group (MSS experience) or the comparison group (traditional classroom safety curriculum). Each student in the intervention group was asked to complete a series of three surveys. The first survey was given before the MSS visit (Fall 2009), the second immediately following the MSS visit (Fall 2009), and a third given 6 months after the MSS visit (Spring 2010) to measure knowledge retention. Students in the comparison group were asked to complete two surveys. The first survey was given at the same time as the intervention group (Fall 2009) and the second was given after the completion of the traditional classroom safety curriculum (Spring 2010). RESULTS: Students scored on average 5.67 of 10 (5.56-5.80) before any safety instruction was given. After MSS instruction, mean scores showed a significant increase to 7.43 of 10 (7.16-7.71). Such increase was still measurable 6 months after the intervention 7.34 (7.04-7.66). The comparison group saw a significant increase in their mean scores 6.48 (6.10-6.89), but the increase was much smaller than the intervention group. CONCLUSIONS: Community-based injury prevention programs are essential to reducing preventable injury and deaths from trauma. This study demonstrates that a hands-on program is more effective than traditional methods for providing safety knowledge.