Patients have long been given daily,
routine chest X-rays in hospital intensive care units around the developed
world, for no good medical reasons. Just because of decades of habit.
But recent studies have shown they are a waste of time and resources, not to mention being potentially hazardous because of the repeated radiation.
Such X-rays don’t detect more problems, don’t alter mortality rates, the length of stay in ICU, or the number of days patients are hooked up to breathing machines, recent studies have shown.
So when doctors at St. Paul’s Hospital in downtown Vancouver decided to instigate a stop to the practice, they managed to find cost savings of $40,000 annually by ordering 70-per-cent fewer routine X-rays. Each X-ray test costs about $40.
In the process, they spared patients from X-ray radiation and freed up staff time more more proven interventions.
“Not to sound stupid, but it was one of those things we were used to doing out of tradition, because of thinking it was the right thing to do. But it was one of those things for which there was no evidence of benefit,” said intensive care specialist Dr. Peter Dodek. He led a study of the practice as a scientist with the Centre for Health Evaluation and Outcome Sciences at St. Paul’s and the University of B.C.
The American College of Radiology used to recommend daily chest X-rays for patients on ventilators. But the recommendation has now changed because of evidence that such routine tests are not necessary.
Frequent chest X-rays are, however, still necessary for patients with symptoms of heart and lung distress or those freshly hooked up to tubes and catheters that could pose complications.
St. Paul’s began to rethink its policy a few years ago when five residents in internal medicine read about a comprehensive study in France showing that daily chest X-rays of ICU patients were unnecessary. As part of their postgraduate medical training and a project on patient care quality improvement, they decided to launch their own study.
“Our intention was not to eliminate chest X-rays because some patients do need them. After all, we are talking about patients who are intubated, and often on mechanical ventilation. They’re at risk of acquiring pneumonia in hospital so that’s why daily chest X-rays were thought to be useful, to check for those signs,” Dodek said.
But there are other ways and means to look for signs of pneumonia — fever, white blood cell counts and oxygen levels. Doing a chest X-ray on an ICU patient means radiology technicians have to wheel portable X-ray machines to the bedside, nurses have to lift and reposition seriously ill patients, and clear tubes and catheters out of the way of the X-ray beam. Repositioning patients can result in catheters and tubes coming loose.
Once the patient is readied for the scan, nurses and other health professionals must stand back so they’re not exposed to the radiation.
The St. Paul’s project team drew up a list of conditions that still require routine chest X-rays and worked with computer programmers to change the electronic order-entry system so that all requisitions include at least one of the required indicators. They spread the word by putting up posters and giving educational sessions. They also hope to have their work published in a medical journal.
The interior, long a sore point with Corvette owners and critics (literally and figuratively) is redesigned to be world class in comfort and function. The entire interior is covered in premium materials, including leather, aluminum and carbon fiber. Base and competition seats are heated and cooled, with beefy side bolsters to hold driver and passenger firmly in place. All controls are oriented toward the driver. The instrument panel includes two 8-inch video displays -- the one behind the steering wheel changes based on the selected drive mode.
And here's the kicker, that push-you-over-the-top insight that may prompt a Porschephile or Tifosi to look toward Motown for that next big ride: Chevy says if you can afford today's Corvette, you'll be able to afford this one, too.
For all the changes -- only two parts carry over: a roof panel latch and a cabin air filter -- this Stingray is every bit a Corvette, with a long hood, short deck,Add depth and style to your home with these large format polished tiles. and wide and low stance, with a decidedly Italianate flair.
Corvette chief engineer Tadge Juechter's mission was formidable: This Corvette had to perform better than any Vette that came before it,We open source indoor tracking system that was developed with the goal of providing at least room-level accuracy. including the current car, already among the world's best. It had to be more comfortable than the car it replaces. And it had to help GM meet ever-tightening fuel-economy regulations,Creative glass tile and stone mosaic tile for your distinctive kitchen and bath. or at least do as little harm to the Corporate Average Fuel Economy score as possible.
No, Juechter could not get by with a mere makeover of the sixth-generation car, a car that's been in production since the 2005 model year and is itself based heavily on the fifth-gen Corvette introduced as a '97. A makeover -- an easy, less costly and tempting solution -- would not prove to the world that Chevrolet and GM have returned to the business of building exceptional, breathtaking cars.
A Tremec seven-speed manual with active rev matching for upshifts and downshifts. This is an evolution of the six-speed manual in the C6. The rev-matching system uses a Hall effect sensor mounted on the transaxle to sense the start of gear changes and command the engine computer to bump up engine revs for a smoother shift. It can be turned off with a steering-wheel switch for heel-and-toeing.
Fourth gear in the Tremec is a direct 1:1 drive,Buy today and get your delivery for £25 on a range of ceramic tile for your home. and the top three gears are overdrive, bolstering the Stingray's fuel-economy numbers.
Each rail's center section is hydroformed. Attached to the front and rear of the center rails are large aluminum castings, with ribbing for added strength, that are the attachment points for the front and rear suspensions. At the end of each casting are sections of extruded high-strength aluminum, in a figure-eight shape, that form the front and rear crush zones for the car.
Much like the frame, the C7's suspension looks familiar at first glance, including the transverse-mounted composite springs front and rear. But every component has been reworked.
The Stingray keeps the short-/long-arm suspension and rear transaxle design from the C6. Steering knuckles, bearings and links are stiffer.Creative glass tile and stone mosaic tile for your distinctive kitchen and bath. More weight was cut via hollow lower control arms and switching the rear toe links from steel to aluminum. But for extra powertrain rigidity, the torque tube that connects the back of the engine and the front of the rear transaxle to keep the driveshaft in alignment was changed from aluminum to steel.
The Stingray's steering plays a key role in driving feel. Juechter says the C7's steering system is five times stiffer than that found in the C6. It includes an electric power-steering unit, a stiffer steering column and steering gear mounted to the front cradle.
But recent studies have shown they are a waste of time and resources, not to mention being potentially hazardous because of the repeated radiation.
Such X-rays don’t detect more problems, don’t alter mortality rates, the length of stay in ICU, or the number of days patients are hooked up to breathing machines, recent studies have shown.
So when doctors at St. Paul’s Hospital in downtown Vancouver decided to instigate a stop to the practice, they managed to find cost savings of $40,000 annually by ordering 70-per-cent fewer routine X-rays. Each X-ray test costs about $40.
In the process, they spared patients from X-ray radiation and freed up staff time more more proven interventions.
“Not to sound stupid, but it was one of those things we were used to doing out of tradition, because of thinking it was the right thing to do. But it was one of those things for which there was no evidence of benefit,” said intensive care specialist Dr. Peter Dodek. He led a study of the practice as a scientist with the Centre for Health Evaluation and Outcome Sciences at St. Paul’s and the University of B.C.
The American College of Radiology used to recommend daily chest X-rays for patients on ventilators. But the recommendation has now changed because of evidence that such routine tests are not necessary.
Frequent chest X-rays are, however, still necessary for patients with symptoms of heart and lung distress or those freshly hooked up to tubes and catheters that could pose complications.
St. Paul’s began to rethink its policy a few years ago when five residents in internal medicine read about a comprehensive study in France showing that daily chest X-rays of ICU patients were unnecessary. As part of their postgraduate medical training and a project on patient care quality improvement, they decided to launch their own study.
“Our intention was not to eliminate chest X-rays because some patients do need them. After all, we are talking about patients who are intubated, and often on mechanical ventilation. They’re at risk of acquiring pneumonia in hospital so that’s why daily chest X-rays were thought to be useful, to check for those signs,” Dodek said.
But there are other ways and means to look for signs of pneumonia — fever, white blood cell counts and oxygen levels. Doing a chest X-ray on an ICU patient means radiology technicians have to wheel portable X-ray machines to the bedside, nurses have to lift and reposition seriously ill patients, and clear tubes and catheters out of the way of the X-ray beam. Repositioning patients can result in catheters and tubes coming loose.
Once the patient is readied for the scan, nurses and other health professionals must stand back so they’re not exposed to the radiation.
The St. Paul’s project team drew up a list of conditions that still require routine chest X-rays and worked with computer programmers to change the electronic order-entry system so that all requisitions include at least one of the required indicators. They spread the word by putting up posters and giving educational sessions. They also hope to have their work published in a medical journal.
The interior, long a sore point with Corvette owners and critics (literally and figuratively) is redesigned to be world class in comfort and function. The entire interior is covered in premium materials, including leather, aluminum and carbon fiber. Base and competition seats are heated and cooled, with beefy side bolsters to hold driver and passenger firmly in place. All controls are oriented toward the driver. The instrument panel includes two 8-inch video displays -- the one behind the steering wheel changes based on the selected drive mode.
And here's the kicker, that push-you-over-the-top insight that may prompt a Porschephile or Tifosi to look toward Motown for that next big ride: Chevy says if you can afford today's Corvette, you'll be able to afford this one, too.
For all the changes -- only two parts carry over: a roof panel latch and a cabin air filter -- this Stingray is every bit a Corvette, with a long hood, short deck,Add depth and style to your home with these large format polished tiles. and wide and low stance, with a decidedly Italianate flair.
Corvette chief engineer Tadge Juechter's mission was formidable: This Corvette had to perform better than any Vette that came before it,We open source indoor tracking system that was developed with the goal of providing at least room-level accuracy. including the current car, already among the world's best. It had to be more comfortable than the car it replaces. And it had to help GM meet ever-tightening fuel-economy regulations,Creative glass tile and stone mosaic tile for your distinctive kitchen and bath. or at least do as little harm to the Corporate Average Fuel Economy score as possible.
No, Juechter could not get by with a mere makeover of the sixth-generation car, a car that's been in production since the 2005 model year and is itself based heavily on the fifth-gen Corvette introduced as a '97. A makeover -- an easy, less costly and tempting solution -- would not prove to the world that Chevrolet and GM have returned to the business of building exceptional, breathtaking cars.
A Tremec seven-speed manual with active rev matching for upshifts and downshifts. This is an evolution of the six-speed manual in the C6. The rev-matching system uses a Hall effect sensor mounted on the transaxle to sense the start of gear changes and command the engine computer to bump up engine revs for a smoother shift. It can be turned off with a steering-wheel switch for heel-and-toeing.
Fourth gear in the Tremec is a direct 1:1 drive,Buy today and get your delivery for £25 on a range of ceramic tile for your home. and the top three gears are overdrive, bolstering the Stingray's fuel-economy numbers.
Each rail's center section is hydroformed. Attached to the front and rear of the center rails are large aluminum castings, with ribbing for added strength, that are the attachment points for the front and rear suspensions. At the end of each casting are sections of extruded high-strength aluminum, in a figure-eight shape, that form the front and rear crush zones for the car.
Much like the frame, the C7's suspension looks familiar at first glance, including the transverse-mounted composite springs front and rear. But every component has been reworked.
The Stingray keeps the short-/long-arm suspension and rear transaxle design from the C6. Steering knuckles, bearings and links are stiffer.Creative glass tile and stone mosaic tile for your distinctive kitchen and bath. More weight was cut via hollow lower control arms and switching the rear toe links from steel to aluminum. But for extra powertrain rigidity, the torque tube that connects the back of the engine and the front of the rear transaxle to keep the driveshaft in alignment was changed from aluminum to steel.
The Stingray's steering plays a key role in driving feel. Juechter says the C7's steering system is five times stiffer than that found in the C6. It includes an electric power-steering unit, a stiffer steering column and steering gear mounted to the front cradle.
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