RESUMO
PURPOSE: To determine the effect of a large-scale picture archiving and communication system (PACS) on in- and outpatient utilization of radiologic services. MATERIALS AND METHODS: Data were collected at the Baltimore Veterans Affairs (VA) Medical Center (BVAMC) before and after implementation of an enterprise-wide PACS; the numbers and types of imaging examinations performed for fiscal years 1993 and 1996 were evaluated. These data were compared with those from a similar academic medical center, the Philadelphia VA Medical Center (PVAMC), and with aggregate data obtained nationally for all VA hospitals over comparable periods. RESULTS: Inpatient utilization, defined as the number of examinations per inpatient day, increased by 82% (from 0.265 to 0.483 examinations per patient day) after a transition to filmless operation at BVAMC. This is substantially greater than the increases of 38% (from 0.263 to 0.362 examinations per patient day) and 11% (from 0.190 to 0.211 examinations per patient day) at the film-based PVAMC and nationally, respectively. Outpatient utilization, defined as the number of examinations per visit, increased by 21% (from 0.108 to 0.131 examinations per visit) at BVAMC, compared with a 1% increase (from 0.087 to 0.088 examinations per visit) at PVAMC and a net decrease of 19% (from 0. 148 to 0.120 examinations per visit) nationally. CONCLUSION: The transition to filmless operation was associated with increases in inpatient and outpatient utilization of radiologic services, which substantially exceeded changes at PVAMC and nationally over the same interval.
Assuntos
Serviço Hospitalar de Radiologia/estatística & dados numéricos , Sistemas de Informação em Radiologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Baltimore , Diagnóstico por Imagem/estatística & dados numéricos , Fluoroscopia/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Philadelphia , Sistemas de Informação em Radiologia/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricosRESUMO
A 73-year-old woman with hypoparathyroidism and hypocalcemic seizures was treated successfully with intravenous calcium. These symptoms developed 19 years after thyroid surgery. Prior to this admission, there had been many opportunities to make the diagnosis, had it been considered. Chronic hypocalcemia and hypoparathyroidism may present with varying signs and symptoms.
Assuntos
Hipocalcemia/complicações , Hipoparatireoidismo/complicações , Convulsões/etiologia , Idoso , Gluconato de Cálcio/uso terapêutico , Feminino , Humanos , Hipocalcemia/fisiopatologia , Hipoparatireoidismo/etiologia , Hipoparatireoidismo/fisiopatologia , Complicações Pós-Operatórias , Tireoidectomia/efeitos adversos , Fatores de TempoRESUMO
Mycobacterium fortuitum utilizes certain stereoisometric mixtures of individual multimethyl branched alkanes as sole carbon source, including 2,6(R), 10(S), 14(RS)-tetramethylhexadecane; 2.6(R), 10(S), 14(RS)-tetramethylheptadecane; 2,6(RS), 10(RS)-trimethyltetradecane, and 2,6(R), 10(S)-trimethylpentadecane. Products of oxidation isolated from the bacterial lipids were acids derived predominantly from oxidation of the isopropyl terminus of each alkane, except in the case of 2,6(RS), 10(RS)-trimethyltetradecane. With the latter, acids from oxidation at either terminus were detected in comparable proportions.
