Ethical Practice And Research Appraisal In Clinical Radiology

1. Have a quick search of the recent literature (the last five years) and find an article on ethical practice in your discipline.

Reflect on the major lessons you have learnt from this article about how ethics inform practice in your discipline and post a comment about this to the week 2 discussion board.

2. Think about the last time you were doing something at work (or on clinical placement) and asked yourself:

• Why am I doing this like this?
• How could I research updated evidence on this task?

3. Post a summary of your responses to the discussion board

Post any questions you have about the critical appraisal process discussed during Monday's lecture to the Assessment 2 discussion board sub forum "questions about conducting critical appraisal".

Consider a recent research publication that you thought was important.

List the article and write a paragraph to argue and justify your appraisal of the internal and external validity of the study.

Post your summary to the Week 3 Activity discussion board.

4 Think about the last time you were doing something at work (or on clinical placement). 

Reflecting on your readings and class materials, pos that problem as a research question, as a hypothesis and a null hypothesis.

Part A

From the article provided by Cannavale et al., (2013) the malpractices performed in clinical radiology and the reasons for worrying regarding these malpractices are understood. From this article it has been revealed that with the advancement in the overall medical practice, the professional role of radiologists has also been evolved including increased involvement of clinical patient management. The study helped to gain knowledge regarding the basic principles, ethical and legal issues, which may lead to legal actions against the radiologist or practitioners. It has been revealed that the most common malpractice in radiology field is error in diagnosis, which is followed by procedural complications, then comes inadequate communication with patient or physician. Therefore, these sections needed to be focused more to eliminate these kinds of malpractice from the care settings. All of the above mentioned issues lead to the development of an ethical dilemma. Therefore, to eliminate these kinds of malpractice in care settings, the key strategies identified by authors are following standard of care as long as possible, focusing significantly on adequate communication and information provision to patient, technician, nurses, other care workers, patient’s family and physicians, being careful in off-label use of devices and finally taking liability insurance into consideration. Therefore, accomplishing the duty of care provides the guidance towards ethical consideration in care settings.

During my clinical placement, I have got several different experiences and adopted several skills, which improved my knowledge base as well as problem solving competencies. Within these experiences, I have come up my communication skills, which needed to be improved. While providing the patient’s reports, I attempted to provide them the X-ray plates and CT scan plans and asked to wait for the written reports. However, I identified that most of the patients and their families did not have the knowledge regarding the medical imaging plates and reports. Most of them were reported to wait for the assigned physician to know about the reports, which caused a delay in health care service provision. I have also identified that there were a significant gap in patient physician and patient radiologist’s communication. This gap leads to misinterpretation of disorder in some cases and non-adherence with patient’s care plans (Aynsley-Green et al., 2012). Thus, I identified the importance improving communication in my clinical practice. When I reviewed that why am I doing like this, while providing a patient his X-ray report, I observed that he was unable to understand the medical information about his health on neither the plates nor in the report. I used my critical thinking skills and attempted to educate the patient regarding the report and medical imaging plates. For every patient, I attempted to educate them, while providing the reports, through thorough discussion. It improved their awareness as well as improved the communication within patient and radiography.

Now, it is important to improve the process to gain the maximum efficiency of the entire procedure. For this, I searched the existed literature to review the ways to improve patient radiologist communication and how effectively they can be educated to improve their awareness as well as to improve the communication efficient, to ultimately eliminating the misdiagnosis, medical errors, malpractice or inadequacy in communication and delay in providing health care services. In this context, from the literature search, I revealed that the initial step that could improve the situation is improving the communication skills of all the staffs (Cunningham et al., 2013). It is because a cooperative action by the colleagues would lead to success. Thus, improving the communication with other staffs is one way to improve the situation. On the other hand, another way to improve the situation that I got from literature search is to provide a session to patient or patient’s family, while undergoing the radiography procedure. It would improve their awareness, help to understand the report interpretation as well as build a strong communication network with the patient, while enhancing the adherence of the patient with appropriate care plan (Grieve, Plumb & Khan, 2014). Another study revealed that merging information of the patient with the medical imaging information would help the radiologist professionals to improve communication. For instance, while protocoling a CT scan exam, I specifically need to know the patient’s blood urea nitrogen and creatinine levels. In this context, integrating advanced data intelligence software, this level of functionality can be achieved (Abujudeh & Bruno, 2012). This process could also promote a measure of goodwill between the radiologist and the referring physician.

Part B

In this part, the research article published by Arthurs et al., (2014) has been appraised critically. The article named “Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice” aimed to review the diagnostic yield of this practice. In this context, initially, authors discussed the background of the research topic significantly with the explanation of the key issue focused in this article. The article identified the key diagnosis and assessment done during routine perinatal and paediatric post-mortem plain radiography, which included presence of skeletal dysplasias, bony abnormalities or fractures. In the next stage, the methods and data collection procedure has been demonstrated. Authors provided in depth information regarding the sample size of the patients, the inclusion and exclusion criteria as well as the study period. They included 1027 cases in single institution over a two and half years period. They included babygrams and full skeletal surveys and images were preported before autopsy is done in all the included cases. The methods were discussed constantly. To ensure accuracy and absence of biasness, radiology findings were cross-referenced with the autopsy findings with an autopsy database. It ensured the authenticity of the methods undertaken in the research work. In the next part, authors estimated results and represented in tables and diagrams. To improve the efficiency of the data collected in the research, authors also provided information through original images of diagnostic post-mortem radiograph. The cost analysis for performing these procedures annually has also been showed in flow chart format for making it easier for the readers to understand the results.

The authors also calculated the false positive findings on routine plain radiographs, which were mainly over-interpretation of features. Authors found that 12.3 % overall abnormality rate; whereas they found significantly high rate of abnormality in case of skeletal survey compared to babygram, as 90 % of the babygrams were normal. 33 incidental noncontributory cases, 19 contributory, 20 diagnostic, and 2 false positive cases were found in total 74 abnormal babygrams (Arthurs et al., 2014). The cost analysis revealed that a policy for performing selected radiogram compared to routine action is cost saving in case of foetal post mortem radiography. A thorough discussion was represented by the authors to compare their findings with the others and to evaluate the outcomes. The findings met the research objectives and concluded that the routine post-mortem paediatric radiography for neonates and foetuses are not diagnostically useful or cot saving. Rather authors claimed for further research to find out better and evidence-based protocol towards an effective and cost saving procedure. However, the study limitations were not represented in the study.

The external validity of the study is high, as the study findings are useful in many other settings and promote the further research for more cost saving techniques to be identified. On the other hand, the internal validity is also high for this paper as all the steps in the research has been undertaken in ethical and efficient ways, with cross referencing and by avoiding confounding (Hulley et al., 2013). Therefore, the researchers have conducted the study with significant efficiency to maximize the accuracy of the findings.

In part B, I have discussed and reflected one of work during clinical placement, which was focused on communication with the patients, during clinical radiography practices. In this context, I have reflected that there were significant communication gap within the radiologist and the patients, which creates a knowledge gap within patients and make them non-adherent to the clinical care practices or delays in providing proper clinical care services. Thus, I have discussed the evidence-based ways to improve the communication and patient education regarding the radiographic diagnosis and reports (Aynsley-Green et al., 2012). In this context, I have revealed several ways through literature search for improving communication with patients like improved communication with colleagues, educational session with patient or family member during the clinical radiology practice and integration of software for merging other information about patient. In this context, reflecting on the readings the following hypothesis can be made.

Is it possible to improve the communication with patient and improve the efficiency of patient’s health improvement by patient education, software integration and interpersonal communication improvement?

Alternative hypothesis: H₁: patient education, software integration and interpersonal communication improvement would improve the communication with patient and improve the efficiency of patient’s health improvement through improved adherence with the care procedure

Null hypothesis: H₀: patient education, software integration and interpersonal communication improvement would not improve the communication with patient followed by patient’s health improvement

Reference:

Abujudeh, H. H., & Bruno, M. A. (Eds.). (2012). Quality and safety in radiology. Oxford University Press.

Arthurs, O. J., Calder, A. D., Kiho, L., Taylor, A. M., & Sebire, N. J. (2014). Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice. Pediatric radiology, 44(3), 252-257.

Aynsley-Green, A., Cole, T. J., Crawley, H., Lessof, N., Boag, L. R., & Wallace, R. M. M. (2012). Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. British medical bulletin, 102(1), 17-42.

Cannavale, A., Santoni, M., Mancarella, P., Passariello, R., & Arbarello, P. (2013). Malpractice in radiology: what should you worry about?. Radiology research and practice, 2013.

Cunningham, N., Reid, L., MacSwain, S., & Clarke, J. R. (2013). Ethics in radiology: Wait lists queue jumping. Canadian Association of Radiologists Journal, 64(3), 170-175.

Grieve, F.M., Plumb, A.A. & Khan, S.H., (2014). Radiology reporting: a general practitioner's perspective. The British journal of radiology.

Hulley, S. B., Cummings, S. R., Browner, W. S., Grady, D. G., & Newman, T. B. (2013). Designing clinical research. Lippincott Williams & Wilkins.