Optimization of Radiology Reports for Intensive Care Unit Portable Chest Radiographs: Perceptions and Preferences of Radiologists and ICU Practitioners.

PURPOSE: The aim of the study was to evaluate opinions and perceptions of radiologists and referring practitioners regarding reports of portable chest radiography (pCXR) obtained in the intensive care unit (ICU). MATERIALS AND METHODS: A total of 1265 referring practitioners and 76 radiologists were invited to participate in 2 internet-based surveys, containing 15 and 17 multiple choice questions, respectively, similarly presented to both groups, utilizing a Likert scale or multiple choices. Results were compared using the Fisher exact test or χ test. RESULTS: One hundred ninety-two referring practitioners and 63 radiologists answered the surveys, resulting in response rates of 15% and 83%. The majority of radiologists and referring practitioners are satisfied with the quality of the reports; however, radiologists and referring practitioners disagree about the reports' clinical value and impact, the referring practitioners having a more positive view. Both groups overwhelmingly agree that pertinent clinical information is crucial for optimal image interpretation. The 2 groups differ in their preferences regarding report style and information content, with radiologists strongly supporting concise reports emphasizing temporal changes and major findings, whereas referring practitioners prefer more complete, itemized structured reports describing support devices in detail. CONCLUSIONS: The results substantiate the perceived clinical value of radiologist reports for pCXR, from the perspective of referring practitioners. Nonetheless, there is disagreement regarding report structure and content. Several issues were raised, offering opportunities for improvement, which may increase referring practitioners' satisfaction and positively impact patient outcomes. Any strategy to implement standardized structured reports for pCXR will have to satisfy referring practitioners' needs while optimizing radiologists' efficiency, will have to be widely accepted, and will have to fulfill the overarching goal of maximizing the value of pCXR reports.

Barriers to a trial of atherosclerosis prevention in systemic lupus erythematosus.

OBJECTIVE: The effectiveness of aggressive management of traditional risk factors for accelerated atherosclerosis in systemic lupus erythematosus (SLE) has been advocated but not proven. We conducted a pilot, randomized, controlled trial of known prevention medications (pravastatin, ramipril, aspirin, and a combination B vitamin) plus individualized cardiovascular prevention education. We describe our experience in recruiting and retaining patients with SLE in this trial. METHODS: Patients with SLE by American College of Rheumatology criteria who lived within 1 hour of the hospital and had visits within the past 3 years were screened. All eligible patients were contacted by the principal investigator who was not their physician. The reasons for nonparticipation were elicited in a nonjudgmental manner. RESULTS: A total of 662 patients met the selection criteria for the study. Of these, 295 patients (45%) with contraindications to study medications were excluded. Ninety-seven (40%) of 244 eligible patients refused to participate. More than 40% of those phoned were unwilling to participate and, among those, 19% felt they were too sick, too well, or taking too many medications already. A total of 41 patients were enrolled in the trial, and 22 dropped out within 4 months. CONCLUSION: SLE is a chronic disease, and the development and testing of interventions aimed at the prevention of long-term sequelae are of paramount importance. Prevention trials in SLE face serious challenges, including the recruitment and retention of participants. Our experience provides insights into the barriers to participation in randomized prevention trials in SLE.