Appropriateness of computed tomography and magnetic resonance imaging scans in a rural regional hospital in South Africa: A 6-year follow-up study.

BACKGROUND: Requests for computed tomography (CT) and magnetic resonance imaging (MRI) scans by doctors with different levels of experience have cost and risk implications globally. Evidence-based appropriateness criteria guide doctors to the suitable use of radiology imaging. There are few studies regarding appropriateness of CT requests in the South African (SA) context. Previous research in the Garden Route district of Western Cape Province, SA, evaluated the appropriateness of scans. OBJECTIVES: To review the appropriateness of CT and MRI scans done in a 6-year follow-up study at one facility. METHODS: This was a retrospective descriptive study. All CT and MRI scans performed during October 2018 at George Hospital were classified according to American College of Radiology guidelines as: usually appropriate (UA), might be appropriate (MBA), or not appropriate (NA). Stratified analysis allowed simple statistics and some comparison with the previous study. RESULTS: A total of 515 CT and MRI scans were included, of which 81.4% were UA, 7.4% MBA and 11.2% NA. Most scans were requested by medical officers (n=255), followed by consultants (n=126) and junior doctors (n=70). Medical officers made the majority of inappropriate requests. Second-year interns requested the lowest number of inappropriate scans, with registrars not requesting any inappropriate scans. Most of the inappropriate scans were requested after hours. Thirty-seven of the 123 (30.1%) after-hours scans were inappropriately requested compared with 21 of 392 (5.4%) scans during normal working hours, which were inappropriate. CONCLUSIONS: Although the majority of scans were being ordered appropriately, pre-authorisation by experienced physicians and incorporation of guidelines would make requests more complete and possibly more appropriate, especially after hours.

[Alkaloids and industry today]. / Alcaloïdes et industrie, aujourd'hui.

The importance of alkaloids and heterosides extracted from plants is clearly established. A specialised industry makes them available to drug companies by means of technological processes which now make a wide range of extractions possible. Due to the large investments in equipment and raw materials, the procedures and processes must be optimised so that each extraction corresponds to a specific procedure dictated by a large number of parameters. Competitivity is only obtained at this cost. The raw material is the major limitation: because of the variability of drugs and because of economic factors which include the risk of falsifications. The large sums of money invested mean that a greater financial support, from outside of the company, will probably be necessary in the future, which is likely to fragilise the company.