MONDAY, March 1 (HealthDay News) -- Too many primary care doctors are making inappropriate patients referrals for CT and MRI scans, according to a new study.
Researchers analyzed medical records from 459 elective outpatient CT and MRI examinations conducted at Harborview Medical Center in Seattle. All the patients were referred by primary care physicians.
"Of the 459 reviewed, 74 percent were considered appropriate and 26 percent were considered inappropriate. Fifty-eight percent of the appropriate studies were positive and affected subsequent management, while only 24 percent of inappropriate studies were positive, affecting management," said lead author Dr. Robert L. Bree.
Inappropriate exams included brain CT for chronic headache, lumbar spine MRI for acute back pain, and knee or shoulder MRI in patients with osteoarthritis.
"Our study shows that CT and MRI examinations ordered in the outpatient primary care setting are frequently not appropriate based on the application of a national radiology benefit management company's evidence-based guidelines," Bree said.
"A high percentage of examinations not meeting appropriateness criteria and subsequently yielding negative results suggest a need for tools to help primary care physicians improve the quality of their imaging decision requests," he added.
The study appears in the March issue of the Journal of the American College of Radiology.
Bree said the findings are "important information for policy makers as they struggle with physicians and patients who are unhappy with restrictive utilization management programs and payers and the public who are looking for ways to decrease health care costs and increase quality and safety of exams in an era of higher awareness of effects of excess radiation. A reasonable compromise might be found in the newly emerging clinical decision support systems."
More information
The U.S. Food and Drug Administration has more about medical imaging.
MONDAY, March 1 (HealthDay News) -- In a life-and-death situation, how much time people have to react has a lot to do with whether they behave selfishly or selflessly, if a new critique of the infamous Titanic and Lusitania ocean liner disasters is any indication.
The comparative look at who survived two of the 20th century's most infamous shipping calamities suggests that the so-called "economic theory" of human behavior -- namely, that in the face of disaster, rational self-preservation trumps social norms and rules -- does not always hold water.
"What would you do?" asked study co-author Benno Torgler, a professor of economics and finance at the Queensland University of Technology in Brisbane, Australia. "Would you attempt to save your own life at whatever cost to others, or would you help others and put your life at stake for others? One would think that selfish and self-preserving behavior predominates. However, we provide evidence ... that this is not always the case."
To discern what makes threatened people tick, the researchers compared data on passenger and crew members and their reactions to the two maritime disasters. Manifests indicate that passenger composition was similar on the ships, with 62 percent to 65 percent of the passengers male.
In both instances, Torgler and his team noted, the ship captains ordered their crew to save female passengers and children first -- because of a scarcity of lifeboats on the Titanic and because of too little time to launch lifeboats on the Lusitania.
Younger, stronger and more agile passengers would have been expected to have a better chance of surviving both sinkings, the researchers noted. That's not, however, what they found.
On the Titanic, survival more closely tracked the crew's directive, which reflected accepted social norms: females 16 to 35 years of age had a much higher probability of surviving the disaster than did men of a similar age. In terms of economic class and social power, first-class passengers were found to have better survival rates than their poorer shipmates.
On the Lusitania, on the other hand, both men and women aged 16 to 35 had a greater chance of survival than did younger or older passengers. And bearers of first-class passage actually were less likely to survive than third-class passengers.
The researchers concluded that, on the Lusitania, a "survival of the fittest" pattern was in play, whereas prevailing social protocols and captain orders were enforced on the Titanic and respected by crew and passengers alike. A report on their findings is published in this week's online issue of the Proceedings of the National Academy of Sciences.
What accounts for the differences in behavior? Torgler and his colleagues think it was mainly a question of timing.
The Lusitania, they pointed out, sank just 18 minutes after it was torpedoed by a German U-boat on May 7, 1915, killing more than 1,198 people from a manifest of 1,258 passengers and 691 crew members.
By contrast, the Titanic stayed afloat for two hours and 40 minutes after striking ice on the night of April 14, 1912. Although 1,512 people died in that disaster -- from among 1,300 passengers and 886 crew onboard -- the extra coping time afforded the Titanic's crew and passengers a sort of psychological buffer against selfishness, according to the researchers.
People on the Titanic were better able to resist the powerful instinct to save oneself by using superior physical prowess to flee -- a mindset that seemed to prevail on the much more quickly doomed Lusitania, the researchers said.
On the Titanic, time appeared to favor adoption of respect for social norms, which favored women, while fostering a better exchange of lifesaving advice that probably favored those in the upper class with the best access to such information, they said.
What's more, the added time also would have allowed for the dissipation of adrenaline, which triggers a fight-or-flight reaction that, by contrast, would have been in play throughout the entire Lusitania sinking.
"Time seems to be a crucial element," noted Torgler. "If people have time to interact and communicate, social norms and helping behavior emerges. Children, families with children and women in general have then a higher probability of surviving, while men have a higher willingness to surrender a seat on a lifeboat."
Other factors, however, might also have influenced behavior on the two ships, the researchers acknowledged. For example, the fact that Lusitania passengers already knew of the gruesome fate of the Titanic just three years earlier could have contributed to a less restrained reaction. Differing ship structures and the fact that the Lusitania incident occurred in a wartime context also might have affected passenger thinking, they said.
Yet Torgler and his colleagues suggest that, in general, their observations could help planners devise more effective disaster-reaction strategies by broadening the understanding of how people juggle survival instincts with social pressures when confronting extreme situations.
For his part, Robert J. Gatchel, a professor of clinical health psychology at the University of Texas at Arlington, agreed that timing does affect behavior during a disaster, while noting that other issues of perception are almost certainly also at play.
"On the Titanic, there was clearly a predetermined perception that it was unsinkable," he remarked. "There was all the pre-travel publicity about that. So the passengers probably had a feeling that 'Yeah, we're evacuating the ship but it's not really going to go down, and we're doing it for a precautionary reason.' There was probably a perception that this wasn't really a disaster, at least at first. So instead of an immediate fight-or-flight response, there was a perception of control, for better or worse. And we know that that perception will reduce stress and affect behavior," Gatchel said.
"On the other hand, people on the Lusitania were no longer under the illusion that these big ships could not go down. They knew of the great publicity of the Titanic, and they didn't want to be part of another incident like that. So they lost their sense of control, which increased stress levels. And then it became a free-for-all in terms of survival of the fittest. And I'm also sure just in terms of the cadence of the voice of the officers the urgency to get off was greater, if for no other reason than because another torpedo could be fired. So, I think probably general panic was not only among the passengers but among the officers themselves," Gatchel said.
More information
National Public Radio has more on the economics of human behavior 
.
