ISSN:0899-3459    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In the use of magnetic resonance imaging (MRI) in medicine and in the conduct of MRI research, conflicts of interest are routinely generated. These conflicts are not necessarily unique to MRI and are not necessarily considered malpractice or misconduct. It is important, however, for clinicians and researchers to understand what constitutes a conflict of interest and how to mitigate the potential adverse effects of those conflicts on patients and on the integrity of research. It also is important for medical professionals to understand the changes in the clinical and research environments that make conflicts of interest more prevalent and more of a concern to policy makers. Finally, it is important for medical professionals who work with MRI to understand some of the characteristics of MRI that might increase the prevalence of conflicts of interest in clinical practice and research.

ISSN:0899-3459    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Breast magnetic resonance imaging (MRI) screening has been shown to detect early breast cancer. The main challenge ahead for breast MRI screening is to prove its effectiveness in reducing breast cancer mortality. While this challenge is commonly viewed as a scientific, technological, and clinical one, it also carries ethical components. This article is concerned with the risks and benefits of MRI screening that should be explained to screening participants and discusses the evidence needed by policy makers who ultimately will determine a just allocation of health care resources to MRI breast cancer screening.

ISSN:0899-3459    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

One of the most controversial areas of nonaccidental injury is the medical diagnosis of inflicted central nervous system injury and its impact on medical, social, and legal outcomes for children and families. This review addresses the role of the neuroradiologist in the clinical care of the pediatric patient and as an expert medical witness in the area of nonaccidental injury.

ISSN:0899-3459    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Despite marked advances in the treatment and prevention of coronary artery disease (CAD) during the last decade, CAD and its complications continue to account for 20% of all deaths in the United States, more than other cause of death. Moreover, half of those who die suddenly of an acute myocardial infarction have no prior symptoms or overt manifestations of their underlying CAD. As our understanding of the pathophysiology of coronary atherosclerosis improves, diagnostic tests utilizing magnetic resonance (MR) imaging and gated computed tomography are being developed to screen for significant CAD in symptomatic individuals and in those who are preclinical or asymptomatic. Patients with known or suspected CAD might be candidates for MR studies of myocardial perfusion, myocardial contraction under stress, MR coronary arteriography, and plaque characterization. One rationale would be to uncover patients before they have a silent heart attack to institute preventative therapies. Although clinical studies have not definitively demonstrated the efficacy of these modalities, screening sites are proliferating and patients are demanding screening tests for CAD. Radiologists interpreting these tests should understand their underlying rationale, the data referenced to substantiate their use, and their responsibility to inform the patient of the results. This review describes current concepts of the pathophysiology of CAD, the rationale for the various screening tests for CAD that are in use or in development, and the potential value of the results of screening to individual patients. The ethical issues embodied in the performance of screening tests for CAD are placed in the context of the appropriate role of the radiologist as a physician interacting directly with a patient.

ISSN:0899-3459    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The growth of managed care could have widespread effects on the structure and functioning of the health care delivery system, potentially influencing all patients, even those not enrolled in managed care plans. One important mechanism by which managed care could have such broad effects is by influencing technology development and adoption. This article examines available literature on the effects of managed care activity on technology adoption and the implications of any effects on patient care, outcomes, and health care costs. Existing literature supports the view that managed care has contributed to slowing the adoption of new technologies, particularly the high-cost, high-profile technologies that have been the focus of the most attention. The literature outlining the effects of managed-care–induced changes in technology adoption on patient care and outcomes is not large, but what literature there is tends not to find negative effects on patient care and outcomes. Specific evidence about costs also is somewhat sparse, but it suggests that managed care has contributed to some reduction in health care spending, although the extent to which savings will persist over time is unclear. Although evidence thus far does not suggest important detrimental effects of managed care on care or outcomes and even indicates some benefit through savings, it should be noted that existing literature has only explored a small number of the many technologies and services that might have been influenced, and there remain issues for the future that deserve vigilance.

ISSN:0899-3459    

出版商:OVID    

年代:2002

数据来源: OVID