REFERRING PHYSICIANS' KNOWLEDGE OF THE RADIATION DOSES FOR COMMONLY RADIOLOGICAL INVESTIGATIONS IN NASIRIYA TURKISH HOSPITAL.

OBJECTIVE: The aim: To assess the referring physicians' knowledge of the radiation doses for commonly radiological investigations in Nasiriya Turkish Hospital (NTH). PATIENTS AND METHODS: Materials and methods: A cross-sectional study of referring physicians in NTH was carried out. A two-part questionnaire was distributed to all Referring Physicians' apart from radiologists. Radiological examinations were listed and Referring Physicians' were asked to estimate equivalent doses using the dose of postero-anterior chest X-Ray as a reference. Questions on knowledge of radiation (including radiation exposure and doses, protection, maximizing effectiveness, impacts of ionizing radiation) and utilization of referral guidelines were included. RESULTS: Results: A total of 50 were distributed to the participants, 32 were returned and deemed acceptable for inclusion in this study. The participants' demographic data shows that most are male 21 (65.6%), while 11 (34.4%) are female. Up to 23 (71.9%) of participants had knowledge of ionizing radiation, but only 7 (21.9%) physicians were aware of its unit measurement. Most participants were unable to accurately estimate the radiation dose absorbed by patients during the various radiological examinations; 68.8% had no knowledge of radiations' stochastic and non-stochastic impacts; 14 (43.7%) were aware of the referral guidelines and used them. The majority of the participants 24 (75%) are aware that USS is safe for pregnant women. only 1(3%) physician knew that there is no ionizing radiation involved in MRI. CONCLUSION: Conclusion: Most participants did not able to accurately estimate the radiation dose absorbed by patients during the various radiological examinations.

Which Aspects of the CanMEDS Competencies are Most Valued in Radiologists? Perspectives of Trainees From Other Specialties.

PURPOSE: Radiologists work primarily in collaboration with other healthcare professionals. As such, these stakeholder perspectives are of value to the development and assessment of educational outcomes during the transition to competency-based medical education. Our aim in this study was to determine which aspects of the Royal College CanMEDS competencies for diagnostic radiology are considered most important by future referring physicians. METHODS: Institutional ethics approval was obtained. After pilot testing, an anonymous online survey was sent to all residents and clinical fellows at our university. Open-ended questions asked respondents to describe the aspects of radiologist service they felt were most important. Thematic analysis of the free-text responses was performed using a grounded theory approach. The resulting themes were mapped to the 2015 CanMEDS Key Competencies. RESULTS: 115 completed surveys were received from residents and fellows from essentially all specialties and years of training (out of 928 invited). Major themes were 1) timeliness and accessibility of service, 2) quality of reporting, and 3) acting as a valued team member. The competencies identified as important by resident physicians were largely consistent with the CanMEDS framework, although not all key competencies were covered in the responses. CONCLUSIONS: This study illustrates how CanMEDS roles and competencies may be exemplified in a concrete and specialty-specific manner from the perspective of key stakeholders. Our survey results provide further insight into specific objectives for teaching and assessing these competencies in radiology residency training, with the ultimate goal of improving patient care through strengthened communication and working relationships.

Awareness of indications for device therapy among a broad range of physicians: a survey study.

AIMS: Cardiac resynchronization therapy (CRT) and primary prophylactic implantable cardioverter-defibrillators (ICDs) are underutilized in heart failure (HF). This may originate from an unawareness of device benefits and indications among physicians responsible for HF care and referral. We aimed to describe the awareness of indications for device therapy in a generalized sample of Swedish physicians. METHODS AND RESULTS: A randomly selected sample of Swedish physicians specializing in cardiology, internal medicine, and family medicine and interns (5% of eligible physicians, n = 519) was invited to fill in a 23-item survey, testing their awareness of indications for device therapy and, as comparison, pharmacological therapy. Acceptable awareness (AA) of CRT indication was predefined as recognizing that a left bundle branch block on ECG warrants further evaluation for CRT. Acceptable awareness of ICD indication was predefined as recognizing that ejection fraction ≤35% alone, without a history of ventricular tachycardia, is sufficient to warrant a primary prophylactic ICD. The response rate was 37% (n = 168). Overall, 32% met AA of CRT indication, and significantly less (15%) met AA of ICD indication. Specialist certification in cardiology was the only significant predictor for AA [odds ratio (95% confidence interval): 37 (10-138)]. However, even among cardiologists, awareness of ICD indications was low (61% with AA). Guideline-recommended indications for pharmacological therapy were conceived significantly better (P = 0.02) than device therapy [median (interquartile range) of correct answers: 50% (33-50) compared with 36% (14-57)]. CONCLUSIONS: The study identified an important and substantial awareness gap in the medical community that may explain some of the previously reported low referral rates and utilization of device therapy in HF.

["The total time spent by the general practitioner decreases": The referring physician's view of a palliative day care clinic]. / "Der zeitliche Gesamtaufwand für den Hausarzt sinkt": Die Sicht der Zuweisenden auf eine palliativmedizinische Tagesklinik.

BACKGROUND: Palliative day-care clinics (PDCCs) can complement inpatient and outpatient specialized palliative care. Some studies have shown improvements in the patients'́ symptoms, functional level and psychological well-being, while others have not. This study aimed to document the experience of referring physicians with PDCCs. METHOD: A postal questionnaire was sent to referring physicians between 11/2020 and 3/2021. The questionnaire included open and closed questions about professional background, symptom control, medical / psychosocial benefits for patients and challenges in the collaboration. Closed, 5-point scaled questions were analyzed descriptively with IBM SPSS Statistics 25®, open questions with a thematic content analysis using MAXQDA 2020®. RESULTS: Of the 96 referring physicians contacted, 76 questionnaires were returned (79%), 73 of which could be analyzed. Most referring physicians were general practitioners (57%), followed by oncologists (28%). 12% had completed further training in palliative medicine and had been working with patients with palliative care needs for an average of almost 19 years. On average, they had referred 24 patients (range 1-200) to a PDCC. 93% said that inpatient stays were delayed or avoided by PDCCs. 97% were of the opinion that their patients achieved a (great or rather great) benefit from medical treatment, and 96% thought that they benefited (to a great or rather great degree) from psychosocial treatment. 58% said that their own time spent with patients treated at the PDCC had decreased. In addition, a total of 227 open comments on challenges in cooperation, suggestions for optimization, reasons for referring patients and general wishes for PDCCs were analyzed. DISCUSSION: The high response rate to the questionnaires shows that PDCCs are of great importance to referring physicians. They consider the cooperation with PDCCs to be supportive and helpful for both themselves and their patients. CONCLUSION: PDCCs make an important contribution to palliative care. Almost all respondents believe that treatment at a PDCC prevents or delays hospitalization.

Implementing the SCORE system improves the quality of clinical EEG reading.

Objective: To assess whether implementing the freeware version of the SCORE EEG system (Standardized Computer-based Organized Reporting of EEG) leads to improvement in the quality of clinical EEG reading, and whether EEG reports in SCORE EEG are understood and accepted by the referring physicians. Methods: We generated EEG reports in the conventional, free-text style and then using SCORE EEG, in consecutive patients referred to routine EEG. We used the Georgian translation in the SCORE EEG Free Edition. We pre-defined quality indicators consisting of a list of 24 key features that need to be addressed in EEG reports. We compared these quality indicators in free-text reports with SCORE EEG. In addition, EEG reports in SCORE EEG format were assessed by ten referring physicians, who evaluated their usability on a 7-point Likert scale. Results: We included and evaluated EEG reports from 157 patients (80 female; age: 1-75 years; median: 28 years). Fourteen features were reported exclusively in SCORE EEG, four were reported significantly more often in SCORE EEG than in free-text format, and six features were reported equally often in SCORE EEG and in free-text format. Usability aspects of SCORE EEG were highly rated by the referring physicians (median 6-7 on the 7-point Likert scale). Conclusions: The structured system of EEG reporting in SCORE EEG helped the experts reading clinical EEG to cover the important aspects and increase the quality of clinical EEG reports. Significance: Implementing the freeware version of SCORE EEG in underprivileged areas will help improving management of patients with epilepsy.

Accounting for radiation exposure from previous CT exams while deciding on the next exam: What do referring clinicians think?

PURPOSE: To obtain clinicians' views of the need to account for radiation exposure from previous CT scans and the advisability of a regulatory mechanism to control the number of CT scans for an individual patient. METHODS: A convenience survey was conducted by emailing a link to a three-question electronic survey to clinicians in many countries, mostly through radiology and radiation protection contacts. RESULTS: 505 responses were received from 24 countries. 293 respondents (58%) understand that current regulations do not limit the number of CT scans that can be prescribed for a single patient in a year. When asked whether there should be a regulation to limit the number of CT scans that can be prescribed for a single patient in one year, only a small fraction (143, 28%) answered 'No', 182 (36%) answered 'Maybe' and 166 (33%) answered 'Yes'. Most respondents (337; 67%) think that radiation risk should form part of the consideration when deciding whether to request a CT exam. A minority (138; 27%) think the decision should be based only on the medical indication for the CT exam. Comparison among the 4 countries (South Korea, Hungary, USA and Canada) with the largest number of respondents indicated wide variations in responses. CONCLUSIONS: A majority of the surveyed clinicians consider radiation risk, in addition to clinical factors, when prescribing CT exams. Most respondents are in favor of, or would consider, regulation to control the number of CT scans that could be performed on a patient annually.

Do German public reporting websites provide information that office-based physicians consider before referring patients to hospital? A four-step analysis.

BACKGROUND: In recent years, many different performance frameworks and quality assurance systems have been developed to measure health care quality. In Germany, an external quality assurance system for hospitals was introduced in 2005. The data of these systems are often reported by public reporting websites (PRWs) to inform patients and other stakeholders interested in health care systems about health care providers' quality. However, publication is obligatory (at least in Germany) for most of the existing quality assurance measures; some may be reported voluntarily. An important target group for this information is the group of all office-based physicians as they are crucial for patients' hospital choice. However, public reporting initiatives in Germany and other countries have not increased the use of quality reports for hospital choice. OBJECTIVES: (1) To summarize the criteria that office-based physicians consider to be of high, medium, and low importance for hospital selection when referring patients and (2) to examine whether German public reporting websites (PRWs) provide these hospital-related criteria. METHODS: The analysis comprised four steps: 1) Five databases were systematically searched for peer-reviewed English- and German-language literature. 2) The selection of articles was based on compliance with inclusion criteria, and all the criteria relevant to the referral of patients to hospital were extracted. 3) The criteria were then divided into five main categories: structural quality, process quality, outcome quality, patient experience, and referring physicians' experience. In addition, the criteria were classified into three importance categories (high-, medium-, and low-priority criteria) according to their relevance to the referral decision. 4) We investigated whether German PRWs publicly report high-priority criteria. RESULTS: A total of N=11 articles published in peer-reviewed journals met our inclusion criteria. The studies were published in Germany (n=4), the Netherlands (n=3), Denmark, France, Norway, and the USA (n=1 each). In total, N=86 criteria were identified, most of them relating to structural quality (n=43) and process quality (n=26). We found just n=3 outcome quality criteria, only one of which fell in the high-priority category (breast cancer indicators with clinically relevant differences). In total, n=25 low-, n=40 medium-, and n=34 high-priority criteria could be established, which is due to the fact that some criteria had been investigated in several studies evaluating the importance of some criteria differently. Most of the high-priority criteria were related to process quality. All the high-priority structural quality criteria and high-priority outcome quality criteria were available on German PRWs, whereas just 38.5 % of those relating to process quality could be identified on these portals. We also identified 66.7 % of the high-priority criteria regarding patient experience and 50.0 % concerning the referring physicians' experience. Overall, a larger amount of low- and medium-priority criteria are available on German PRWs than high-priority criteria. DISCUSSION: A substantial amount of hospital information regarding structural quality and outcome quality is available on German PRWs. However, the development of further process quality criteria (which are currently underrepresented) should be considered, for example whether hospital physicians continue the medication initiated by office-based doctors. Also, hospital quality reports should be tailored for specific user groups, for instance for referring gynecologists or referring general practitioners (GPs).

Differing Interpretations of Report Terminology Between Primary Care Physicians and Radiologists.

PURPOSE: The lexicons of the radiologist and the referring physician may not be synonymous, which could cause confusion with radiology reporting. To further explore this possibility, we surveyed radiologists and primary care physicians (PCPs) regarding their respective interpretations of report terminology. METHODS: A survey was distributed to radiologists and PCPs through an internal listserv. Respondents were asked to provide an interpretation of the statistical likelihood of the presence of metastatic disease based upon the terminology used within a hypothetical radiology report. Ten common modifying terms were evaluated. Potential responses for the statistical likelihoods included 0%-25%, 26%-50%, 51%-75%, 76%-99%, and 100%. Differences between the groups were evaluated using either a χ2 test or Fisher exact test, as appropriate. RESULTS: The phrases "diagnostic for metastatic disease" and "represents metastatic disease" were selected by a high percentage of both groups as conferring a 100% likelihood of "true metastatic disease." The phrases "cannot exclude metastatic disease" and "may represent metastatic disease" were selected by a high proportion of both groups as conferring a 0% likelihood of "true metastatic disease." Radiologists assigned a higher statistical likelihood to the terms "diagnostic for metastatic disease" (P = .016), "represents metastatic disease" (P = .004), "suspicious for metastatic disease" (P = .04), "consistent with metastatic disease" (P < .0001), and "compatible with metastatic disease" (P = .003). CONCLUSION: A qualitative agreement among radiologists and PCPs exists concerning the significance of the evaluated terminology, although radiologists assigned a higher statistical likelihood than PCPs for several phrases.