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Stewardship Could Improve Appropriate Medical Imaging Use

Posted on Sat, Oct 31, 2015
Stewardship Could Improve Appropriate Medical Imaging Use

Stewardship model could guide use to improve clinical outcomes and create value at point of care

FRIDAY, Oct. 30, 2015 (HealthDay News) -- Stewardship may be a promising approach for improving appropriate use of medical imaging technology, according to a perspective piece published in the Oct. 29 issue of the New England Journal of Medicine.

Noting that in addition to playing an essential role in diagnosis and management, medical imaging technology has recently become known for its low-value uses, Daniel J. Durand, M.D., from the Johns Hopkins School of Medicine in Baltimore, and colleagues discussed the need for better stewardship.

The authors described two recent policy changes that have created a more favorable environment for provider-led stewardship: movement toward payment reform and a section of the Protecting Access to Medicare Act of 2014, which mandates that physicians reference appropriateness guidelines from provider organizations when ordering advanced imaging. Health care leaders should signal a transition away from easy imaging access and toward stewardship as part of a quality-improvement strategy. Stewardship programs should be led by imaging specialists, with referring physicians playing a role in shaping local concepts of appropriate imaging. Clinical decision support systems can be an enabling tool and can provide a useful infrastructure to support stewardship.

"Ultimately, health system leaders, referring physicians, and imaging specialists may take the concept of stewardship in new directions, developing a more robust stewardship model that encourages the use of imaging technology to improve patient outcomes and more reliably create value at the point of care," the authors write.

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Suggested Response Provided for In-Flight Medical Emergencies

Posted on Sat, Sep 05, 2015
Suggested Response Provided for In-Flight Medical Emergencies

Article offers tips for physicians providing emergency in-flight medical care.

FRIDAY, Sept. 4, 2015 (HealthDay News) -- In a review article published online Sept. 3 in the New England Journal of Medicine, guidance is offered for physicians providing emergency in-flight medical care.

Jose V. Nable, M.D., from the Georgetown University School of Medicine in Washington, D.C., and colleagues discuss the frequency of in-flight medical emergencies and the potential liabilities surrounding the provision of in-flight medical care.

The authors note that a physician who provides assistance in an in-flight medical emergency creates a doctor-patient relationship, with its associated obligations and liability risk. Liability is usually determined under the laws of the country in which the aircraft is registered. The provider should document care rendered and treatment provided after the event, while being mindful of patient's privacy rights. A suggested approach to handling in-flight emergencies should include asking for permission to treat, if feasible; using an interpreter if necessary, while considering patient privacy; taking a patient history, performing focused physical examination, and obtaining vital signs; administering treatment, with the patient remaining seated while possible; and communication and coordination with ground-based medical resources. The physician should continue to administer care until the condition is stabilized or care is transferred.

"Physicians should be prepared to render care while traveling; physicians must also be aware of the medically austere environment, its related limitations on prudent practice, and the associated liabilities surrounding the delivery of in-flight medical care," the authors write.

One author disclosed financial ties to Allianz Global Assistance.

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