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Biomedical subjects

Howard P Forman

Publications and source records attributed to Howard P Forman.

31 records · Page 2Linked to original sources
PubMed2004

Emergency department image interpretation services at private community hospitals.

PURPOSE: To investigate the methods used at private community hospitals for delivering emergency department (ED) image interpretation services. MATERIALS AND METHODS: The authors contacted a random national sample of 114 hospitals by telephone and administered an "ED Radiology Coverage" questionnaire. The questionnaire included queries about daytime image interpretation duties, nighttime radiology coverage arrangements, and radiologist staffing needs. Results were stratified on the basis of ED patient volumes and trauma center designation and were analyzed statistically by using multivariate and logistic regression analyses. RESULTS: Representatives of 97 EDs responded to the questionnaire. Community hospital radiologists performed daytime primary interpretation of radiographs at 39 (40%) of 97 EDs, computed tomographic (CT) scans at 91 (95%) of 96 EDs, and ultrasonographic images at 87.5 (93%) of 94 EDs. "ED-dedicated" radiologists performed this emergency radiology work in only two (2%) of 97 EDs. During the nighttime, eight (8%) of 97 EDs had no radiology coverage, 80 (82%) of 97 EDs used teleradiology services in some form, and nine (9%) of 97 EDs employed in-house, rotating "non-ED-dedicated" radiologists. Analysis of participant responses revealed that clinicians at 37 (38%) of 97 EDs were able to consult radiologists for nighttime radiography questions, and 87 (92%) of 95 EDs had nighttime CT scans read by radiologists in time for patient care decisions. Twenty-four (25%) of 97 EDs reported radiologist staffing shortages, but only one indicated that it was actively trying to recruit ED-dedicated radiologists. Results of logistic regression analysis indicated that higher ED patient volumes (P =.005) and the presence of a trauma center (P =.02) each significantly increases the probability of higher nighttime levels of radiologist coverage. CONCLUSION: There is great variation in the current provision of emergency radiology services in private community hospitals.

Academic Medical Centers↗
PubMed2004

Implementation of an international teleradiology staffing model.

Although teleradiology is presently being used extensively in the United States-for both overseas subspecialty consultations and overnight coverage of imaging services at domestic medical centers-there has been limited investigation of its potential to help provide staffing support to U.S. medical centers from offshore locations. In this review, the authors describe an empirical assessment of the clinical feasibility and applicability of body computed tomographic (CT) image cases that originated at a U.S. university hospital being interpreted nearly contemporaneously by a staff radiologist in India. During a 3-month period, nonemergent CT cases obtained at a tertiary care institution (Yale-New Haven Hospital) were transmitted daily to a satellite reading facility in Bangalore, India. The cases were interpreted at the satellite reading facility by a faculty member radiologist who maintained hospital privileges and academic appointment at the parent institution in the United States. CT imaging reports were transcribed and uploaded directly to the parent institution's radiology information system. Technical problems temporarily prevented the transfer of image cases twice during the study period. Overall, the project results demonstrated the feasibility and reliability of an international teleradiology staffing model.

Abdominal Neoplasms↗
PubMed2004

Update on the diagnostic radiologist shortage.

OBJECTIVE: The purpose of this study is to present the latest information available on the shortage of diagnostic radiologists. MATERIALS AND METHODS: Four sources of information are available, and we present their data: first, the number of jobs for diagnostic radiologists advertised in Radiology and the American Journal of Roentgenology; second, vacancies in academic radiology departments as of July 1, 2003, ascertained by a survey of these departments; third, the ratio of job listings to job seekers at a major professional placement service, the Professional Bureau of the American College of Radiology (ACR); and fourth, diagnostic radiologists' self-reported workload burden, from the ACR's 2003 Survey of Diagnostic Radiologists. RESULTS: Jobs advertised in September-November 2003 (latest data available) were 28% fewer than in the same months of 2002. Vacancies per department averaged 3.9 in 2003, compared with 5.4 in 2001 and 5.1 in 2002. Listings per seeker were 1.4 in 2002 (latest data available) compared with 3.0 or more in 1999 and 2000. Responses to a question directly tying changes in workload to changes in income indicated that reported desires for workload reduction and workload increase were approximately equal. CONCLUSION: All four information sources have important limitations, but all indicate that the shortage has considerably eased. We plan to study the causes of this easing and continue to monitor the situation.

Academic Medical Centers↗
PubMed2004

MRI in the diagnosis of cartilage injury in the wrist.

OBJECTIVE: Our purpose was to evaluate the accuracy of MRI in identifying articular cartilage abnormalities in the distal radius, scaphoid, lunate, and triquetrum of patients with wrist pain. MATERIALS AND METHODS: Eighty-six MRI examinations of the wrist in 85 patients (41 indirect MR arthrograms and 45 unenhanced [nonarthrographic] MR images) were evaluated. The study population consisted of 47 male (54.7%) and 38 female (45.3%) patients with an average age of 37.5 years (range, 7-62 years). Three experienced musculoskeletal radiologists who were unaware of surgical findings retrospectively evaluated the MRI examinations for cartilage abnormalities in the distal radius, scaphoid, lunate, and triquetrum. All patients underwent arthroscopy of the radiocarpal joint with inspection of the articular surfaces of the distal radius, scaphoid, lunate, and triquetrum. The articular cartilage was evaluated on the basis of the 5-point scale of the Outerbridge classification system. RESULTS: When at least two of the three radiologists had concordant interpretations, sensitivity for abnormalities in the distal radius was 27%; the scaphoid, 31%; the lunate, 41%; and the triquetrum, 18%. Specificity for the distal radius was 91%; the scaphoid, 90%; the lunate, 75%; and the triquetrum, 93%. Weighted kappa values among the three observers showed only fair agreement (0.279-0.360). High-grade more extensive cartilage lesions were no more accurately identified than low-grade lesions. Indirect MR arthrograms were not statistically more sensitive, specific, or accurate than unenhanced studies. No bone was more frequently or less frequently graded correctly or incorrectly with statistical significance. The variables of sex, age, and the presence of multiple bones with lesions did not affect accuracy. CONCLUSION: Our findings suggest that MRI of the wrist with the techniques described is not adequately sensitive or accurate for diagnosing cartilage defects in the distal radius, scaphoid, lunate, or triquetrum.

Adolescent↗
PubMed2003

Emergency radiology coverage: technical and clinical feasibility of an international teleradiology model.

The purpose of the study was to determine the feasibility of international teleradiology, utilizing day-night time differences, for online interpretation of overnight computed tomography (CT) studies. One hundred and two consecutive Emergency Room patients who underwent CT examinations between the hours of 11 pm and 7 am were enrolled. All age groups and study types were included. CT studies were transmitted from the in-hospital PACS system (Kodak, Fremont, Calif.) to a web-based server (Medweb, San Francisco, Calif.). A radiologist in Bangalore, India, working an 8 amto 4 pm day shift, downloaded and reviewed the studies on a desktop PC using a 128-kbps internet connection at 10-20:1 wavelet compression and generated a report. The report was then uploaded to the server, noting the time at upload. Each study report was compared with the official in-house diagnostic report and concordance assessed on a three-point scale. Mean download time was 8.14 s per image. For head CT reports ( n=47), the mean turnaround time for a final transcribed report was 39.5 min. For abdomen/pelvis CT reports ( n=48) the mean turnaround time was 84.4 min. Out of 106 cases, there was discordance between the clinical diagnostic report and the study report in 20 (19%); however, on subsequent review the teleradiology report was found to be correct in 13 of these. Day-night time differences across the globe can be utilized to provide overnight emergency radiology coverage using web-based teleradiology. Scan download and report upload times are within acceptable limits.

Journal Article↗
PubMed2003

MD/MBA programs in the United States: evidence of a change in health care leadership.

PURPOSE: Managerial sciences are playing an increasingly prominent role in the organization and delivery of health care. Despite popular media reports that a rising number of physicians are acquiring a background in this discipline through MD/MBA (medical and master of business administration) programs, no recent study has verified this. This study measured changes in the number and nature of the affiliations between management and medicine in the form of MD/MBA programs in the United States. METHOD: Surveys of admission officers of 125 U.S. allopathic medical schools and of the overseers of each joint MD/MBA degree program were administered in May-October 2001. Main outcome measures included program growth, curriculum and degree requirements, application and admission requirements, and program leadership and organization. RESULTS: The number of MD/MBA programs grew from six to 33 between 1993 and 2001, and 17 more medical schools were considering establishing the joint-degree program. Ten, 15, and 20 programs produced 27, 42, and 61 graduates in 1999, 2000, and 2001, respectively, and over 100 students were expected to graduate per year when all 33 programs matured. Program structures and oversight indicate a spectrum of philosophies regarding the appropriate level of integration of the two degrees. MD/MBA programs apparently attempt to complement medical education with management education rather than the converse. CONCLUSIONS: The growth in the numbers of MD/MBA programs and participants indicates rising cooperation between medical and business schools and increasing interest in management education early in the careers of graduating physicians.

Career Choice↗
PubMed2003

Findings in 2002 from a help wanted index of job advertisements: is the job-market shortage of diagnostic radiologists easing?

OBJECTIVE: The goal of this study is to present the most recent data on the diagnostic radiology job market in the United States using a help wanted index of job advertisements. MATERIALS AND METHODS: All diagnostic radiology positions advertised in the American Journal of Roentgenology and Radiology from January through December 2002 were coded by practice type, geographic location, and subspecialty. Data were compared with the previously published results from 1991 through 2001. RESULTS: From January through December 2002, 5117 positions were advertised for diagnostic radiologists, representing a 10.4% decrease from 2001. The 12-month rolling average of job advertisements peaked at 488 in February 2002 and dropped to 432 by December 2002, a level not seen since August 2000. In 2002, 42.7% of positions advertised were academic, representing a steady increase from 34.0% in 1999. When comparing the 4-year periods 1999-2002 and 1995-1998, a statistically significant proportional increase was found for positions advertised in the Midwest. Statistically significant relative increases were also observed for the subspecialties of abdominal radiology, mammography, neuroradiology, pediatric radiology, chest radiology, and nuclear medicine. Statistically significant relative decreases were seen in general and vascular and interventional positions. CONCLUSION: The absolute demand for diagnostic radiologists nationwide appears to have stabilized during 2002, albeit at a level much higher than in previous years, and may be decreasing. A split seems to have appeared in the market between academia and private practice. Current policy should be directed toward increasing the supply of diagnostic radiologists, especially academicians.

Advertising↗
PubMed2002

State expenditures for tobacco-control programs and the tobacco settlement.

BACKGROUND: Despite controversy surrounding the use of funds arising from settlement agreements with the tobacco industry, little is known about the role of these funds in expenditures for state tobacco-control programs. METHODS: We evaluated state expenditures for tobacco-control programs in fiscal year 2001 in the context of the amount of tobacco-settlement funds received and allocated to tobacco-control programs and in the context of other state-level economic and health data. RESULTS: In 2001 the average state received $28.35 per capita from the tobacco settlement but allocated approximately 6 percent of these funds to tobacco-control programs. The average state dedicated $3.49 per capita (range, $0.10 to $15.47) to tobacco-control programs. The proportion of settlement funds allocated to tobacco-control programs varied from 0 to 100 percent and was strongly related to levels of tobacco-control funding (P<0.001). States with higher smoking rates tended to invest less per capita in tobacco-control programs (P=0.007), as did tobacco-producing states (the mean per capita expenditure was $1.20, as compared with $3.81 in non-tobacco-producing states; P<0.008). In a multivariate analysis, the proportion of the settlement revenue allocated to tobacco-control programs was the primary determinant of the level of total funding; the state tobacco-related health burden was unrelated to program funding. CONCLUSIONS: State health needs appear to have little effect on the funding of state tobacco-control programs. Because only a very small proportion of the tobacco settlement is being used for tobacco-control programs, the settlement represents an unrealized opportunity to reduce morbidity and mortality from smoking.

Health Expenditures↗
PubMed2002

Data from a professional society placement service as a measure of the employment market for physicians.

PURPOSE: To determine whether data from a professional society placement service--the Professional Bureau of the American College of Radiology--are a valid measure of the employment market. MATERIALS AND METHODS: For the United States from 1990 to 1998, the authors compared three placement service measures-the annual number of job listings, job seekers, and listings per seeker-with two presumably valid measures of the employment market-annual total jobs available (which was ascertained from surveys of hiring) and radiologist median income relative to the all-physician median. For the comparisons, both graphic displays of the data and correlation were used. RESULTS: In graphs, patterns of change were similar. The correlation of job listings, which measure demand, with total jobs, which also measure demand, was 0.84 (P =.04). The correlation of (a) job seekers, a measure of supply, and (b) listings per seeker, which involve both supply and demand, with total jobs was substantial but lower: 0.58 (P =.23) and 0.76 (P =.08), respectively. Correlation of the three placement service measures with relative income, which presumably depends on both supply and demand, was 0.80-0.88 (P <.05 for each measure). CONCLUSION: The statistical significance levels of the correlations and the pattern of findings--namely, stronger correlations among measures of the same aspect of the employment market--indicate that these placement service data are valid and reasonably accurate measures of the employment market.

Employment↗
PubMed2002

Evaluation of an emergency radiology quality assurance program at a level I trauma center: abdominal and pelvic CT studies.

PURPOSE: To evaluate the use of a redundant system in improving quality of care in the trauma setting by examining a subset of our quality assurance program. MATERIALS AND METHODS: Five hundred thirty-one consecutive abdominal and pelvic CT reports obtained in patients with trauma at a level I trauma center from August 22, 1999, to August 21, 2000, were retrospectively reviewed. Each case was initially interpreted by a board-certified or board-eligible radiologist during evaluation in the emergency department and was subsequently reviewed by a subspecialty abdominal imaging radiologist as part of a quality assurance program. Nineteen cases were excluded because available information was incomplete, resulting in 512 cases in the current study. Cases with discordant interpretations were followed up to discern care change. RESULTS: Of the 512 trauma cases, 153 (29.9%) showed discordant readings. Review of patient records demonstrated changes in patient care in 12 (7.8%) cases. Three (2.0%) cases were reviewed from the morbidity and mortality records of the Department of Trauma Surgery as a direct result of misinterpretations. Six (4%) cases involved additional diagnostic imaging for reevaluation; in four of these six cases the quality assurance reader's interpretation was confirmed, while in the other two, the initial interpretations were favored. CONCLUSION: Findings suggest that discordant radiologic interpretations most often do not result in a change in patient care and outcome. The quality assurance program did, however, identify and lead to changes in care in a number of cases by providing clinically important additional findings.

Adolescent↗
PubMed2002

Updated findings from a help wanted index of job advertisements and an analysis of the policy implications: is the job-market shortage for diagnostic radiologists stabilizing?

OBJECTIVE: The goal of our study is to present the most recent data on the diagnostic radiology job market in the United States using a help wanted index of job advertisements. MATERIALS AND METHODS: All diagnostic radiology jobs advertised in the American Journal of Roentgenology and Radiology between January 2000 and December 2001 were coded by practice type, geographic location, and subspecialty and were compared with the previously published results from 1991 through 1999. RESULTS: From January 1999 through December 2001, 15,205 positions were advertised for diagnostic radiologists, representing a 284% average per-month increase as compared with the previous 4-year period. The 12-month rolling average of job advertisements peaked in June 2001 at 476 and has since stabilized. Thirty-six percent of positions advertised were academic, identical to the proportion found from 1995 to 1998. A statistically significant relative increase in jobs advertised was noted in the Midwest, and relative decreases were seen in the Northeast, Northwest, Southwest, and (most recently) California. Statistically significant relative decreases were also observed in the number of general radiology, vascular and interventional, and emergency radiology positions. The demand for mammographers, pediatric radiologists, neuroradiologists, abdominal imagers, and chest radiologists all exhibited statistically significant relative increases. CONCLUSION: The absolute demand for both private and academic radiologists continued to grow throughout the country and in all subspecialties, but the pace of increase has slowed dramatically during the past 12 months, especially in the western United States. Current policy should be directed toward training for the areas of greatest need.

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