Asunto(s)
Traumatismos del Brazo/diagnóstico por imagen , Traumatismos de la Pierna/diagnóstico por imagen , Traumatismos del Brazo/diagnóstico , Costos y Análisis de Costo , Errores Diagnósticos , Humanos , Traumatismos de la Pierna/diagnóstico , Planificación de Atención al Paciente , Examen Físico , Radiografía/economía , Estados UnidosRESUMEN
To help curb excessive radiography, we developed a protocol for selecting patients with injured extremities who need x-ray examination, and we tested the protocol prospectively in 848 patients to determine its safety and effectiveness. Strict adherence to the protocol would have reduced x-ray usage by 12 per cent for upper extremities and 19 per cent for lower extremities. The actual reductions were 5 per cent and 16 per cent, respectively, since further reductions were limited by patient's demands for x-ray examinations. One fracture in 287 were missed, but the treatment was appropriate and the outcome satisfactory. By eliminating superfluous x-ray procedures, the protocol could reduce charges by $79 million to $139 million nationwide, without compromising quality of care or increasing malpractice liability. Nevertheless, even the best protocol cannot eliminate all negative x-ray studies. These results should serve as a stimulus for judicious use of radiography, but also as a warning to avoid overzealous cost-containment strategies that would reduce x-ray usage to below a safe threshold.
Asunto(s)
Pruebas Diagnósticas de Rutina/normas , Extremidades/lesiones , Fracturas Óseas/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Connecticut , Control de Costos , Mal Uso de los Servicios de Salud , Humanos , Mala Praxis , Radiografía , Estadística como AsuntoRESUMEN
Meseclazone and its major metabolite, 5-chlorosalicylic acid (5-CSA) have been shown to possess anti-inflammatory, analgesic and antipyretic activity. The comparative effects of these compounds on pletelet aggregation were evaluated in vitro and ex vivo with acetylsalicylic acid (ASA). In vitro, meseclazone and ASA exhibited almost identical inhibitory potency of secondary phase ADP aggregation while 5-CSA was less effective. Moreover, collagen aggregation was inhibited by all three agents: ASA greater than meseclazone greater than 5-CSA. Thrombin-induced aggregation was inhibited to approximately the same extent by 5-CSA and ASA while meseclazone was inactive. The in vitro effects on the release-inducing aggregants were confirmed by ex vivo experiments in rats. These demonstrated that ASA and meseclazone inhibited collagen-induced aggregation 1 and 4 hr after oral administration although ASA was three to four times more active. ASA, but not meseclazone, was still effective 24 hr after administration. Bleeding times in rats 1 and 4 hr following oral administration of meseclazone and ASA were not altered. It is concluded that meseclazone and/or 5-CSA inhibit in vitro and ex vivo platelet aggregation initiated by the release reaction similar to ASA and other non-steroidal anti-inflammatory drugs.