Procedure Logs Research Articles

Requirements for Emergent Neurosurgical Procedures among Patients Undergoing Neuroendovascular Procedures in Contemporary Practice

Provisions for an emergent neurosurgical procedure have been a mandatory component of centers that perform neuroendovascular procedures. We sought to determine the need for emergent neurosurgical procedures following neuroendovascular interventions in 2 comprehensive stroke centers in settings with such provisions. Analysis of retrospectively collected data from procedure logs and patient charts was performed to identify patients who required immediate (before the termination of the intervention) or adjunctive (within 24 hours of the intervention) neurosurgical procedures related to a neuroendovascular intervention complication. The types of neurosurgical procedures and in-hospital outcomes of identified patients are reported as an aggregate and per endovascular procedure-type analyses. We reviewed a total of 933 neuroendovascular procedures performed during 3.5 years (2006-2010). A total of 759 intracranial procedures were performed. There was a need for emergent neurosurgical procedures in 8 patients (0.85% cumulative incidence and 1.05% for major intracranial procedures) (mean age, 46 years; 7 were women); the procedures were categorized as 3 immediate and 5 adjunctive procedures. There were 5 in-hospital deaths (62.5%) among these 8 patients. Neurosurgical procedures performed were external ventricular drainage placement in 6 (6 of 8, 75%) patients, decompressive craniectomy in 1 (12.5%) patient, and both surgical procedures in 1 (12.5%) patient. The need for emergent neurosurgical procedures is very low among patients undergoing intracranial neuroendovascular procedures. Survival in such patients despite emergent neurosurgical procedures is quite low.

An Automated Procedure Logging System Improves Resident Documentation Compliance

The purpose of this study was to determine the effect of an automated procedure logging (APL) system on the number of procedures logged by emergency medicine (EM) residents. Secondary objectives were to assess the APL's effect on completeness and accuracy of procedure logging and to measure resident compliance with the system. This was a before-and-after study conducted at a university-affiliated, urban medical center, with an annual emergency department census of >130,000. The EM residency is a 4-year, Residency Review Committee (RRC)-accredited program with 12 residents per year. We developed software to electronically search and abstract resident procedures documented in the electronic medical record (EMR) and automatically export them into a Web-based residency management system. We compared the mean daily number of procedures logged for two 6-month periods: October 1, 2009, to March 31, 2010 (pre-APL), and October 1, 2010, to March 31, 2011 (post-APL), using a two-sample t-test. We also generated a random sample of 231 logged procedures from both the pre- and post-APL time periods to assess for completeness and accuracy of data transfer. Completeness and accuracy in the pre- and post-APL periods were compared using Fisher's exact test. Aggregate resident compliance with the system was also measured. The mean daily number of procedures logged increased by 168% (10.0 vs. 26.8, mean difference = 16.8, 95% confidence interval [CI] = 15.4 to 18.2, p < 0.001) after the implementation of APL. Procedures logged with the APL system were more complete (76% vs. 100%, p < 0.001) and more accurate (87% vs. 99%, p < 0.001). Most residents (42/48, 88%) used APL to log at least 90% of procedures. Only 4% of procedures eligible for automation were logged manually in the post-APL period. There was a significant increase in the daily mean number of procedures logged after the implementation of APL. Recorded data were more complete and more accurate during this time frame. This innovative system improved resident logging of required procedures and helped our assessment of Accreditation Council for Graduate Medical Education (ACGME) Patient Care and Practice-Based Learning Competencies for individual residents.

Long-term Angiographic and Clinical Outcomes in Completely Versus Incompletely Coiled Ruptured Intracranial Aneurysms

Long-term Angiographic and Clinical Outcomes in Completely Versus Incompletely Coiled Ruptured Intracranial Aneurysms

Promoting Self-Directed Learning Skills in Residency: A Case Study in Program Development

Self-directed learning (SDL) skills are essential for the formation and ongoing competence of today's physicians who work in the context of expanding scientific knowledge and changing health care systems. In 2007-2008, the authors developed a program to promote SDL in the Brown University Family Medicine Residency. Through an iterative process, the project team juggled learning theories (i.e., Knowles' SDL model, Collins' cognitive apprenticeship model, and Quirk's expertise development model) with curricular goals, instructional options, and local constraints to design a practical and theoretically robust intervention.The intervention that emerged from this process features a faculty physician serving as a learning coach who meets individually each month with all second-year residents to assist them in generating learning goals, reflecting on their learning experiences, and practicing evidence-based medicine (EBM) skills. An electronic portfolio serves as a documentation tool that supports reflection; residents record their goals and reflections in the portfolio, which also contains their formative assessments, procedure logs, and special projects. To address the hidden curriculum, the program designers took special care to avoid increasing faculty and resident workload and created a forum for discussion and group reflection. Program evaluation combines qualitative and quantitative methods, such as surveys of and interviews with residents and faculty, to assess changes in residents' SDL and EBM skills and in the program's educational culture. The authors use Kern and colleagues' six-step model for curriculum development to describe both the unfolding of this complex project and the choices that resulted in the current program design.

Bier'S Block for Emergency Department Management of Distal Radius Fractures

Background Distal radius fractures commonly present to emergency departments (ED). Optimum treatment methods remain unclear and individual hospital practices differ. Objectives To ascertain the number and success rate of manipulation under intravenous regional anaesthesia (IVRA) of distal radius fractures, and to determine the re-manipulation rate. Methods Retrospective observational study of patients undergoing manipulation of distal radius fracture under IVRA in the ED from January 2003 to January 2004. The resuscitation room procedure log, hospital computer records, ED records and theatre records were examined for each patient. Results A total of 84 manipulations were performed. Complete information was available for 74 procedures (73 patients). Manipulation was successful in 73.5% with only 19 out of 73 patients requiring operation. All patients were manipulated under IVRA with middle grade or consultant supervision; and 52 (71.2%) patients were managed entirely as outpatients. Conclusion Our policy of manipulating displaced distal radius fractures under IVRA in the ED has a high success rate and allows the majority of patients to be managed as outpatients. This policy may lead to cost savings from a health service financing perspective.

ACCF/ACR/AHA/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR 2008 Health Policy Statement on Structured Reporting in Cardiovascular Imaging

ACCF/ACR/AHA/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR 2008 Health Policy Statement on Structured Reporting in Cardiovascular Imaging

Current Methods in Use for Assessing Clinical Competencies: What Works?

An online survey was used to capture qualitative descriptions of methods used by a veterinary college to assess clinical competencies in its students. Each college was specifically asked about use of the methods detailed in the Toolbox of Assessment Methods developed by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties. Additionally, each college was asked to detail the methods used to ensure competency in each of the nine areas specified by the American Veterinary Medical Association Council on Education. Associate deans of academic affairs or their equivalents at veterinary colleges in the United States, the United Kingdom, Canada, and the Caribbean were contacted by e-mail and asked to complete the survey. Responses were obtained from 24 of 32 colleges. The methods most often used were review of students' medical records (16), checklist evaluation of must-learn skills (16), procedural logs (11), multiple-choice skill examinations (11), case simulations using role-playing (7), short-answer skill examinations (7), global rating of live or recorded performance (7), case simulations using computerized case simulations (7), 360-degree evaluation of clinical performance (4), and standardized patient or client examination (3). Additional methods used included medical record portfolio review, paper-and-pencil branching problems, chart-stimulated oral exams, externship mentor evaluation, performance rubrics for clinical rotations, direct observation and query on cases, video evaluation, case correlation tasks, and an employer survey. Non-realistic models were used more often for skill evaluation than realistic models. One college used virtual-reality models for testing.

Risk factors for acute, moderate to severe donor reactions associated with multicomponent apheresis collections

Legitimate concerns exist over the safety of donors during multicomponent apheresis collections (MACs), when large volumes of red blood cells (RBCs) and plasma are removed. This study evaluates the predictive value of various donor- and procedure-related variables for moderate to severe donor acute adverse events (AAEs). Data on all apheresis donation procedures performed at a large university hospital-based donor center over a 2-year period were obtained by a review of adverse event forms and procedure logs (Trima Accel 5.1, Gambro BCT). Various donor- and procedure-related variables were compared between procedures that resulted in moderate to severe AAEs and those that did not. Moderate to severe AAEs occurred in 53 (0.47%) of 11,333 apheresis donation procedures. The majority of events (96.2%) had predominantly features of vasovagal reactions (VVRs). Females were at significantly higher risk (odds ratio [OR] = 2.8, p < 0.0003) compared to males. Donors who experienced AAEs had significantly lower predonation total blood volume (TBV) and hematocrit (Hct) and higher total RBC loss and net fluid loss at the end of the procedures. Total plasma loss alone was not significantly different between the two groups. Total blood loss was significantly higher among donors who experienced AAEs as a percentage of the donor's TBV. Apheresis collections are well tolerated even when multiple components are collected, with a very low overall incidence of moderate to severe AAEs (0.47%). Small, female donors with lower predonation Hct are at higher risk, especially when RBCs are collected.

Colonoscopy Completion in a Large Safety Net Health Care System

Anecdotally, patients in safety net health care systems have difficulty completing screening and diagnostic colonoscopies, but this is poorly characterized. It is important to understand this phenomenon to improve low rates of colorectal cancer screening in vulnerable populations and to ensure that patients with signs and symptoms complete medically indicated colonoscopic evaluations. We performed a 6-month retrospective review of outpatient endoscopy laboratory scheduling and procedure logs and electronic medical records at Denver Health Medical Center (DHMC), a large safety net health care system, to describe rates and sociodemographic predictors of colonoscopy nonattendance and inadequate (fair/poor) bowel preparation. Predictor variables included patient age, gender, race/ethnicity, procedure indication, and insurance type. The nonattendance rate was 41.7% for all scheduled outpatient colonoscopies without difference between screening and diagnostic procedures. Consistent with non-safety net systems, the rate of inadequate bowel preparation was 30.2%; however, the rate of poor bowel preparation that absolutely precluded an exam was 9.9%. Correctional care patients had markedly higher rates of nonattendance and inadequate bowel preparation compared with other groups. A very large proportion of patients scheduled for colonoscopy in a large safety net health care system do not attend their procedures, and among those who do, there is a high rate of inadequate bowel preparation leading to incomplete and aborted evaluations. Interventions are needed to promote the more efficient use of a limited and expensive resource and to achieve higher rates of screening and medically indicated diagnostic colonoscopies in vulnerable patient populations.

Using videotaped objective structured clinical examination as a tool for reflection on communication skills

Reflection is invaluable in the process of lifelong learning. In medical education literature, reflection has been used to address concrete clinical competencies, eg patient and procedural logs and surgical techniques. This paper reports on a pilot project engaging paediatric residents in reflective exercise on communication skills using the videotaped objective structured clinical examination (V-OSCE). The objective of the paper is to assess the exercise's feasibility and usefulness, as well as the learners' perception of the process and their ability to participate. The paper also shares lessons learned about instituting reflection on communication skills into the residency training curriculum, and discusses remaining challenges. Finally, the paper offers observations about the unique experience of international medical graduates as they engage in learner-centred assessment.

Using videotaped objective structured clinical examination as a tool for reflection on communication skills

Reflection is invaluable in the process of lifelong learning. In medical education literature, reflection has been used to address concrete clinical competencies, eg patient and procedural logs and surgical techniques. This paper reports on a pilot project engaging paediatric residents in reflective exercise on communication skills using the videotaped objective structured clinical examination (V-OSCE). The objective of the paper is to assess the exercise's feasibility and usefulness, as well as the learners' perception of the process and their ability to participate. The paper also shares lessons learned about instituting reflection on communication skills into the residency training curriculum, and discusses remaining challenges. Finally, the paper offers observations about the unique experience of international medical graduates as they engage in learner-centred assessment.

Emergency Medicine Clerkship Encounter and Procedure Logging Using Handheld Computers

BackgroundTracking medical student clinical encounters is now an accreditation requirement of medical schools. The use of handheld computers for electronic logging is emerging as a strategy to achieve this. ObjectivesTo evaluate the technical feasibility and student satisfaction of a novel electronic logging and feedback program using handheld computers in the emergency department. MethodsThis was a survey study of fourth-year medical student satisfaction with the use of their handheld computers for electronic logging of patient encounters and procedures. The authors also included an analysis of this technology. ResultsForty-six students participated in this pilot project, logging a total of 2,930 encounters. Students used the logs an average of 7.6 shifts per rotation, logging an average of 8.3 patients per shift. Twenty-nine students (63%) responded to the survey. Students generally found it easy to complete each encounter (69%) and easy to synchronize their handheld computer with the central server (83%). However, half the students (49%) never viewed the feedback Web site and most (79%) never reviewed their logs with their preceptors. Overall, only 17% found the logging program beneficial as a learning tool. ConclusionsElectronic logging by medical students during their emergency medicine clerkship has many potential benefits as a method to document clinical encounters and procedures performed. However, this study demonstrated poor compliance and dissatisfaction with the process. In order for electronic logging using handheld computers to be a beneficial educational tool for both learners and educators, obstacles to effective implementation need to be addressed.

Emergency Medicine Clerkship Encounter and Procedure Logging Using Handheld Computers

Tracking medical student clinical encounters is now an accreditation requirement of medical schools. The use of handheld computers for electronic logging is emerging as a strategy to achieve this. To evaluate the technical feasibility and student satisfaction of a novel electronic logging and feedback program using handheld computers in the emergency department. This was a survey study of fourth-year medical student satisfaction with the use of their handheld computers for electronic logging of patient encounters and procedures. The authors also included an analysis of this technology. Forty-six students participated in this pilot project, logging a total of 2,930 encounters. Students used the logs an average of 7.6 shifts per rotation, logging an average of 8.3 patients per shift. Twenty-nine students (63%) responded to the survey. Students generally found it easy to complete each encounter (69%) and easy to synchronize their handheld computer with the central server (83%). However, half the students (49%) never viewed the feedback Web site and most (79%) never reviewed their logs with their preceptors. Overall, only 17% found the logging program beneficial as a learning tool. Electronic logging by medical students during their emergency medicine clerkship has many potential benefits as a method to document clinical encounters and procedures performed. However, this study demonstrated poor compliance and dissatisfaction with the process. In order for electronic logging using handheld computers to be a beneficial educational tool for both learners and educators, obstacles to effective implementation need to be addressed.

Utilization of Personal Digital Assistants (PDAS) by Pediatric and Emergency Medicine Residents

The objective of the present study was to investigate the current personal digital assistant (PDA) usage patterns of the residents and their interest in future PDA-based applications. A cross-sectional survey was conducted among the Pediatrics (Peds) and Emergency Medicine (EM) residents in an urban teaching hospital. Data points included level of training, specialty of training, experience of use of different PDA devices, use of current software applications, and interest in future applications. A total of 60/74 (81%) eligible residents participated in the study. Palm® (Palm Inc., Sunnyvale, CA) was the most commonly used operating system (82%). Among the PDA users, 82% reported using the device several times a day, and 16% used them a few times a week. The most commonly used applications included the simple calculator (81%), drug references (80%), medical calculators (75%), electronic textbooks (66%), and schedule and contact information (42%). In addition, residents showed interest in using PDA applications for procedure logs, patient tracking, and prescription writing. No significant differences were noted in the frequency and expertise of using PDAs between the Peds and EM residents ( p = 0.29). Our data show current trends of use of PDAs by Peds and EM residents and their interest for future applications.

Are Commonly Used Resident Measurements Associated with Procedural Skills in Internal Medicine Residency Training?

BackgroundAcquisition of competence in performing a variety of procedures is essential during Internal Medicine (IM) residency training.PurposesDetermine the rate of procedural complications by IM residents; determine whether there was a correlation between having 1 or more complications and institutional procedural certification status or attending ratings of resident procedural skill competence on the American Board of Internal Medicine (ABIM) monthly evaluation form (ABIM-MEF). Assess if an association exists between procedural complications and in-training examination and ABIM board certification scores.MethodsWe retrospectively reviewed all procedure log sheets, procedural certification status, ABIM-MEF procedural skills ratings, in-training exam and certifying examination (ABIM-CE) scores from the period 1990–1999 for IM residency program graduates from a training program.ResultsAmong 69 graduates, 2,212 monthly procedure log sheets and 2,475 ABIM-MEFs were reviewed. The overall complication rate was 2.3/1,000 procedures (95% CI: 1.4–3.1/1,000 procedure). With the exception of procedural certification status as judged by institutional faculty, there was no association between our resident measurements and procedural complications.ConclusionsOur findings support the need for a resident procedural competence certification system based on direct observation. Our data support the ABIM’s action to remove resident procedural competence from the monthly ABIM-MEF ratings.

Community Discernment: Getting Nonprocedural Documentation Right—A First Step to Exemplary Accreditation

Although the Graduate Medical Educational community has had much experience with procedural case logs, they have had little with nonprocedural case logs. Practical experiences are at the heart of physician development. It is important for residents to reflect on their experiences, for program directors to understand the range of experiences actually achieved by each of their residents, and for regulators including both the residency review committee and the boards to have information to determine whether programs and residents meet standards for accreditation and certification. Although some of the lessons learned from procedural case logs will be helpful in determining how best to implement nonprocedural case logs, in general, new ground is being broken. An opportunity exists for the graduate medical education community to engage in a series of clarifying conversations about how to best capture the authentic experiences of residents and how to use the information to promote improvement. Conditions that will help the community discern the best path forward include: clarity of purpose, commonly agreed-upon principles, and the creation of a reliable structure for communication and feedback—a structure that enables trust and improvement. On June 22, 2006, representatives of the Association of Program Directors in Pediatrics (APPD), the Pediatric Residency Review Committee (RRC), and the Accreditation Council for Graduate Medical Education (ACGME) met to have a conversation about how best to proceed with the implementation of the nonprocedural case logs focused on capturing the continuity clinic experience. ACGME’s new mission, vision, values, and strategic priorities guided its perspective. ACGME’s mission is to improve health care by assessing and advancing the quality of resident physicians’ education through accreditation. Its vision is exemplary education. Its values are accountability, excellence, and professionalism. These values constitute principles that could guide ongoing dialogue. By accountability, ACGME requires that its processes are open and transparent; that it is responsive to both the educational community and the health of the public; and that its results are reliable, valid, and consistent. By excellence, it means accreditation that is efficient and effective, outcomes-based, improvement oriented, and innovative. By professionalism, ACGME means that its actions are respectful and collaborative, responsive, ethical, and fair. The ACGME recently completed a self-study that in

Innovative Remedial Cementing Solution Provides Annular Isolation in Duyong B-4

SummaryWhether a cement-squeeze operation results in an annular seal depends heavily on how far the cement can penetrate and disperse in the fine channels of a partially cemented annulus. In many cases, a conventional- or microfine-cement slurry will dehydrate and bridge off before it can achieve its objectives (Nelson et al. 1990). This paper describes the use of an engineered, optimized slurry for a squeeze operation in the Duyong B-4 well, which had a perforated zone that demonstrated a low rate of seawater injectivity. This paper also presents the slurry design and properties, execution procedure, and prejob and post-job log evaluations.After several years of production, gas bubbles appeared in various locations throughout the Duyong field. Shallow seismic readings showed gas charging in several shallow gas layers throughout the Duyong field. Several wells were investigated as possible contributors to the charging of the shallow sandstone layers, and Duyong B-4 was selected as a probable contributor. Duyong B-4 is a gas well that was completed in November 1983 with four producing zones. In September 2003, this well was selected as a test well to evaluate the cement quality behind the casing. Both cement-bond logs and ultrasonic-imaging logs showed gas and fluid channels behind the casing. An optimized cement slurry (OCS) was engineered and tested in the laboratory under well conditions. Results showed excellent penetration in narrow gaps, optimum fluid-loss control, and low rheology, both at surface and downhole conditions.The slurry was used in the squeeze operation; post-job logs demonstrated the success of the treatment. The slurry penetrated the narrow gaps without dehydrating, and good mechanical properties were achieved in short setting times (Moulin et al. 1997). These properties are especially important in gas-producing wells, and they met all the objectives set forth by the client.

Trauma Nurse Specialists’ Performance of Advanced Skills Positively Impacts Surgical Residency Time Constraints

The Accreditation Council for Graduate Medical Education imposed 80-hour work week constraints on residency programs in July 2003. Certain programs were granted an additional 10 per cent for specific educational purposes, bringing restrictions to 88 hours per week. The increased demand for residents to leave the hospital has placed teaching institutions in exhaustive situations to provide comprehensive patient care. In response to the work hour constraints among residents and emergency room staff, a unique group of registered nurses, trauma nurse specialists (TNSs), were credentialed with advanced practice skill sets. Governed by practice guidelines and overseen by a medical director, TNSs perform invasive procedures that are normally the responsibility of the surgical resident. The purpose of this study was to evaluate work hours saved for surgery residents using credentialed nurses (TNSs). Procedure logs were maintained by the TNSs over a 6-month period, and surgical house staff (postgraduate year 1-3) over a 4-month period. A total of 423 procedures were recorded, reflecting time taken for attempted/completed procedures and complications. Resident procedures numbered 98; TNS procedures numbered 325. TNSs spent an average of 42 hours per month (10.6 hours per week) completing advanced procedures with no statistical difference in time or complications compared with surgical residents. By using the TNSs, work hours for surgery residents were saved while maintaining a safe and reliable work atmosphere for patients.

House officer procedure documentation using a personal digital assistant: a longitudinal study

BackgroundPersonal Digital Assistants (PDAs) have been integrated into daily practice for many emergency physicians and house officers. Few objective data exist that quantify the effect of PDAs on documentation. The objective of this study was to determine whether use of a PDA would improve emergency medicine house officer documentation of procedures and patient resuscitations.MethodsTwelve first-year Emergency Medicine (EM) residents were provided a Palm V (Palm, Inc., Santa Clara, California, USA) PDA. A customizable patient procedure and encounter program was constructed and loaded into each PDA. Residents were instructed to enter information on patients who had any of 20 procedures performed, were deemed clinically unstable, or on whom follow-up was obtained. These data were downloaded to the residency coordinator's desktop computer on a weekly basis for 36 months. The mean number of procedures and encounters performed per resident over a three year period were then compared with those of 12 historical controls from a previous residency class that had recorded the same information using a handwritten card system for 36 months. Means of both groups were compared a two-tailed Student's t test with a Bonferroni correction for multiple comparisons. One hundred randomly selected entries from both the PDA and handwritten groups were reviewed for completeness. Another group of 11 residents who had used both handwritten and PDA procedure logs for one year each were asked to complete a questionnaire regarding their satisfaction with the PDA system.ResultsMean documentation of three procedures significantly increased in the PDA vs handwritten groups: conscious sedation 24.0 vs 0.03 (p = 0.001); thoracentesis 3.0 vs 0.0 (p = 0.001); and ED ultrasound 24.5 vs. 0.0 (p = 0.001). In the handwritten cohort, only the number of cardioversions/defibrillations (26.5 vs 11.5) was statistically increased (p = 0.001). Of the PDA entries, 100% were entered completely, compared to only 91% of the handwritten group, including 4% that were illegible. 10 of 11 questioned residents preferred the PDA procedure log to a handwritten log (mean ± SD Likert-scale score of 1.6 ± 0.9).ConclusionOverall use of a PDA did not significantly change EM resident procedure or patient resuscitation documentation when used over a three-year period. Statistically significant differences between the handwritten and PDA groups likely represent alterations in the standard of ED care over time. Residents overwhelmingly preferred the PDA procedure log to a handwritten log and more entries are complete using the PDA. These favorable comparisons and the numerous other uses of PDAs may make them an attractive alternative for resident documentation.

A phylogenetic effect on strontium concentrations in angiosperms

A Residual Maximum Likelihood (REML) procedure was used to compile Sr concentrations in 103 plant species from experiments with Sr concentrations in 66 plant species from the literature. There were 14 species in common between experiments and the literature. The REML procedure log e-transformed data and removed absolute differences in Sr concentrations arising from soil factors and exposure times to estimate mean relative Sr concentrations for 155 species. One hundred and forty-two species formed a group with a normal frequency distribution in mean relative Sr concentration. A nested hierarchical analysis of variance (ANOVA) based on the most recent molecular phylogeny of the angiosperms showed that plant species do not behave independently for Sr concentration but that there is a significant phylogenetic effect on mean relative Sr concentrations. Concentrations of Sr in non-Eudicots were significantly less than in Eudicots and there were significant effects on Sr concentrations in the dataset down the phylogenetic hierarchy to the family level. Of the orders in the dataset the Cucurbitales, Lamiales, Saxifragales and Ranunculales had particularly high Sr concentrations and the Liliales, Poales, Myrtales and Fabales particularly low Sr concentrations. Mean relative Sr concentrations in 60 plant species correlated with those reported elsewhere for Ca in the same species, and the frequency distribution and some phylogenetic effects on Sr concentration in plants were similar to those reported for Ca. This analysis of mean relative Sr concentrations in 155 plant species across the angiosperm phylogeny might be helpful for modelling 90Sr in food chains, predicting radiological doses to flora, and selecting species for phytomonitoring and phytoremediation of 90Sr.