UK undergraduate aspirations and attitudes survey: do we have a perception problem in clinical radiology?

AIM: To understand medical students' potential long-term career choices, with particular reference to radiology, and their current perceptions and experiences of radiology and radiologists, with the aim to help inform future initiatives for undergraduate and early postgraduate medical education and workforce strategies. MATERIALS AND METHODS: An invitation to an online survey was sent to all undergraduate medical students at a large UK medical school, using Likert-style, multiple choice and ranking questions. A quantitative approach was used to explore these responses (n=328). RESULTS: Radiology ranked only 10th out of 14 specialties for long-term career preference amongst medical student respondents (n=328). Radiology was judged as being "low status", but enabled a "good" work-life balance. Medical students considered making an impact on patient diagnosis and level of intellectual challenge as positive influences of a potential career in radiology. Perception of radiology by the public, patient relationship/contact time, perception of radiology by other clinicians, variation of work, and radiology work environment were all perceived more negatively. CONCLUSION: Radiology remains a specialty with limited exposure and experience for undergraduate students, who appear to be incompletely aware of the scope and range of the work of modern radiologists. Greater exposure to radiology teaching in the undergraduate curriculum and placements in radiology departments may increase and expedite medical students' understanding and enjoyment of radiology at a juncture where demand for radiology services is increasing rapidly in the UK.

An ORS-ICP-MS method for monitoring trace levels of cobalt and chromium in whole blood samples from hip arthroplasty patients with metal-on-metal prostheses.

OBJECTIVE: To develop a rapid and reliable method, using an octopole reaction system (ORS) ICP-MS, capable of monitoring trace levels of Co and Cr in whole blood samples from hip arthroplasty patients with metal-on-metal prostheses. DESIGN AND METHOD: Whole blood is diluted 10-fold with an alkaline diluent and analyzed using an Agilent 7500 CE ORS-ICP-MS. RESULTS: Limit of quantification of 0.03 µg/L Co and 0.20 µg/L Cr in patient samples. <6% covariance obtained for quality control materials analyzed over 10 runs. CONCLUSION: This method is capable of monitoring trace levels of Co and Cr in diluted whole blood samples with a vial to vial run time of approximately 2 min. Results are comparable to those obtained using high resolution (HR) ICP-MS with sample digestion.

Driving with a forearm plaster cast: patients' perspective.

BACKGROUND: Forearm plaster casts are commonly used in orthopaedic practice for the treatment of fractures of the wrist and carpal bones. A common question put by patients seeks to clarify suitability to drive a motor vehicle. DVLA guidelines do not specifically comment about temporary immobilisation in a cast. METHODS: A questionnaire was sent to 248 adult patients who had recently been treated in Colles' or scaphoid-type casts to determine the driving habits of the patients and their attitudes to the legality and safety of driving with a cast. RESULTS: Of those who responded, 87% considered it unsafe to drive a car with a plaster cast. 79% thought it should be illegal. Only 9% of patients reported driving while immobilised, and these tended to be young men who did not inform any authority. Previous literature is confusing and there appears to be little consensus among orthopaedic surgeons about letting these patients drive. Clarification is reported from the Medical Advisory Group at the DVLA and the Head of Road Policing Business Area for the Association of Chief Police Officers. CONCLUSION: It is recommended that all medical professionals advise their patients that they should not drive while immobilised in an upper limb plaster cast.

A hydroxyapatite-coated Insall-Burstein II total knee replacement: 11-year results.

We report the clinical and radiographic outcome of a consecutive series of 138 hydroxyapatite-coated total knee replacements with a mean follow-up of 11 years (10 to 13). The patients were entered into a prospective study and all living patients (76 knees) were evaluated. The Hospital for Special Surgery knee score was obtained for comparison with the pre-operative situation. No patient was lost to follow-up. Radiographic assessment revealed no loosening. Seven prostheses have been revised, giving a cumulative survival rate of 93% at 13 years. We believe this to be the longest follow-up report available for an hydroxyapatite-coated knee replacement and the first for this design of Insall-Burstein II knee.

Endomyocardial biopsy in pediatric heart transplant recipients: a useful exercise? (Analysis of 1,169 biopsies).

The objective of this study was to define the diagnostic yield for endomyocardial biopsy (EMB) procedures performed for various indications in a large pediatric heart transplant population. Endomyocardial biopsy procedure has been employed as the 'gold standard' for rejection surveillance. Previous studies have questioned the value of surveillance EMB beyond the early post-transplant period. We retrospectively reviewed data on 82 pediatric heart transplant recipients with serial EMB. A total of 1,169 EMB were performed during a follow-up period of 2-149 months (median 41 months). EMB were classified by age at transplantation, time from transplant, immunosuppressive regimen used [tacrolimus vs. cyclosporin A (CsA)] and indication, i.e. surveillance, follow-up after rejection or lowering of immunosuppression, non-specific clinical symptoms and graft dysfunction. During the first year after heart transplantation, surveillance EMB demonstrated significant rejection [International Society for Heart and Lung Transplantation (ISHLT) grade > or = 3A] in 18% of biopsies with the yield being 14-43% for all other indications. Surveillance EMB 1-5 yr post-transplantation were found to have a lower diagnostic yield in infants (4%, vs. 13% in children) and in patients with favorable first-year rejection history (9% vs. 17% in 'frequent rejectors'). Tacrolimus-based immunosuppression was associated with significantly less rejection, but only in the first year post-transplantation (14% in tacrolimus vs. 24% in CsA surveillance EMB, p = 0.035). Surveillance EMB remains an important diagnostic tool for rejection surveillance during the first 5 years after pediatric heart transplantation. Endomyocardial biopsy is particularly warranted after reduction of immunosuppression and for monitoring for ongoing rejection after treatment of acute rejection episodes.