Improvement in the pattern of advice of investigations following rationalization campaign

To assess the magnitude of change in advising pattern of laboratory and radiological investigations during and after campaign emphasizing rational use of these tests. Comparative cross sectional study. Combined Military Hospital Peshawar, Twenty seven months. The laboratory investigation analysis were Blood Glucose, Thyroid Function Tests, Liver Function Tests [LFT], Renal Function Tests [RFT] and Cardiac Markers and radiological tests were X-Rays Chest, Skull, Wrist and Plain Abdomen, Obstetric Ultra Sound [USG] and CT Scan. The awareness was done by Lectures, handouts, feedback advice on test reports and personal communications to the Medical Officers, Nursing Officers and Paramedical Staff. The data was analyzed through Quarterly Returns, records of laboratory and radiology retrieved from Hospital Information System and departmental registers. In some laboratory investigations there was a significant improvement in the advisory pattern e.g. blood glucose fasting instead of random, ALT instead of whole LFT, electrolytes not included in every RFT and abolishing of AST and LDH from cardiac marker profile and TSH only as screening test. In Radiology there was improvement in the rationality of X-Ray chest, X-Ray skull, X-Rays wrist and obstetric USG. CT scan data could not be compared because CT Scan equipment became out of order during the study. There was also reduction in expenses incurred on irrational investigations. A dynamic ongoing process of awareness and realization campaign for medical professionals is required in any public sector medical institute for cultivating a culture of rational use of investigations

Diagnostic accuracy of doppler ultrasound in comparison with venography in the diagnosis of varicose veins of the legs

To determine the diagnostic accuracy of Doppler ultrasound in the diagnosis of varicose veins of legs using venography as gold standard in picking up deep vein thrombosis. Prospective validation study. Place and Duration of study: Six months, 01 Apr -30 Sep 2006 at Radiology Department, Combined Military Hospital, Quetta. Fifty cases were included in study, fulfilling the inclusion and exclusion criteria. The patients sampled were referred by surgeons from out patients department. The sensitivity of Doppler was 75%, specificity 100% and accuracy 98% in picking up deep venous thrombosis [DVT]. For the detection of incompetent perforators/reflux disease, at spheno-femoral junction the sensitivity of Doppler ultrasound was 85.7%, specificity 95% and accuracy 94%. At spheno-popliteal junction the sensitivity of Doppler ultrasound was 70%, specificity 100% and accuracy 76%. Patients with varicose veins of legs should be evaluated first with Doppler ultrasound. Venography remains the examination of choice when absolute determination of the presence and extent of thrombus is needed, for the determination of the reflux disease level in obese patients, in patients with severe leg edema or in patients in whom results of Doppler ultrasound is equivocal or negative in the settings of high clinical suspicion