Opinions on advanced practice among diagnostic and therapeutic radiographers: Survey results of an European congress of radiology study.

INTRODUCTION: The exploration of Advanced Practice (AP) in both diagnostic and therapeutic radiography has become a prominent topic of discussion within the radiographic community, prompting an investigation into radiographers' perceptions and the current global status of advanced roles. This study aimed collect data on radiography and radiation therapy AP career paths, and understand radiographers' perceptions of advanced practice at the European Congress of Radiology (ECR) 2020. METHODS: A concise, 15-question web-based survey was distributed through the EFRS Research Hub during ECR 2020. Topics covered included respondents' demographics, educational background, current radiography skills, the landscape of AP in radiography, potential progression avenues in their countries, and key benefits linked to role advancement. RESULTS: The survey garnered responses from 83 radiographers, with a predominant 79.5% (n = 66) representing Europe. Information on the total number of participants approached during the ECR and thus the resulting response rate is not available. Among the findings, a meaningful portion (30%, n = 25) of participants indicated the absence of AP opportunities in their respective country. Notably, an overwhelming majority (97.5%, n = 81) expressed a personal willingness to embrace AP roles. Areas of particular interest to the respondents included radiography reporting (38.6%, n = 32), performing ultrasound examination (13.2%, n = 11), conducting interventional procedures (13.2%, n = 11) and engaging in radiography research (10.8%, n = 9). CONCLUSION: The study indicates a keen interest among surveyed radiographers in pursuing AP, emphasizing the necessity for role recognition. Education, research and job satisfaction emerged as pivotal for AP progression. Despite this, AP availability in Europe is limited. IMPLICATION FOR PRACTICE: There is a need to recognize and address barriers, provide targeted education and training, and promote job satisfaction to facilitate the development of AP in radiography.

An assessment of radiation safety practices for transgender and gender non-binary patients in Irish radiology departments.

INTRODUCTION: Studies indicate there may be inadequate care given to transgender and non-binary (TGNB) patients in healthcare environments, with radiology departments not being equipped to cater for this group. There is currently a deficit in research concerning the use of radiation safety measures for TGNB patients. The purpose of this research was to examine opinions of Irish Radiation Safety Experts (RSE) on current status of radiation safety protocols and techniques in place for TGNB patients and consider any changes necessary. METHODOLOGY: Ten semi-structured interviews were conducted with RSEs from eight Irish hospitals, including five radiation protection officers (RPO) and five medical physicists. Question included: current radiation safety protocols for TGNB patients, potential issues and challenges with current practice, and recommendations of new measures. Coding was used to facilitate content analysis for interpretation of findings. RESULTS: No reference to TGNB patients in local policies or guidelines was evident. Interviews established key radiation safety risks including inadvertent exposure of the foetus and insensitive patient care. Prominent categories identified included additional education, gender identification at patient registration and consideration of current policies and guidelines. The extent to which RSEs promoted the implementation of further measures to radiology departments varied. CONCLUSIONS: A clear lack of guidance and instruction for radiation safety for TGNB patients is evident. Whilst there are few TGNB patients in Irish hospitals, participants believed that inclusive changes should be made concurrent with Ireland's evolving culture and in the interest of equality of patient safety. IMPLICATIONS FOR PRACTICE: Inclusive changes should be made to radiology departments concurrent with Ireland's evolving culture. However, barriers to implementing such measures include a lack of available resources, investment, and instruction from authoritative bodies.

Magnesium(II)-ATP Complexes in 1-Ethyl-3-Methylimidazolium Acetate Solutions Characterized by 31 Mg ß-Radiation-Detected NMR Spectroscopy.

The complexation of MgII with adenosine 5'-triphosphate (ATP) is omnipresent in biochemical energy conversion, but is difficult to interrogate directly. Here we use the spin- 1/2 ß-emitter 31 Mg to study MgII -ATP complexation in 1-ethyl-3-methylimidazolium acetate (EMIM-Ac) solutions using ß-radiation-detected nuclear magnetic resonance (ß-NMR). We demonstrate that (nuclear) spin-polarized 31 Mg, following ion-implantation from an accelerator beamline into EMIM-Ac, binds to ATP within its radioactive lifetime before depolarizing. The evolution of the spectra with solute concentration indicates that the implanted 31 Mg initially bind to the solvent acetate anions, whereafter they undergo dynamic exchange and form either a mono- (31 Mg-ATP) or di-nuclear (31 MgMg-ATP) complex. The chemical shift of 31 Mg-ATP is observed up-field of 31 MgMg-ATP, in accord with quantum chemical calculations. These observations constitute a crucial advance towards using ß-NMR to probe chemistry and biochemistry in solution.

Artificial intelligence: The opinions of radiographers and radiation therapists in Ireland.

INTRODUCTION: Implementation of Artificial Intelligence (AI) into medical imaging is much debated. Diagnostic Radiographers (DRs) and Radiation Therapists (RTTs) are at the forefront of this technological leap, thus an understanding of their views, in particular changes to their current roles, is key to safe, optimal implementation. METHODS: An online survey was designed, including themes: role changes, clinical priorities for AI, patient benefits, and education. It was distributed nationally in the Republic of Ireland via the national professional body, clinical management, and social media. RESULTS: 318 DRs and 77 RTTs participated. Priority areas for development included quality assurance, clinical audit, radiation dose optimisation, and improved workflow for DRs and treatment planning algorithm optimisation, clinical audit, and post processing for RTTs. There was resistance regarding AI use for patient facing roles and final image interpretation. 27.6% of DRs and 40.3% of RTTs currently use AI clinically and 46.1% of DRs and 41.2% of RTTs anticipate reduced staffing levels with AI. 64.9% of DRs and 70.6% of RTTs felt AI will be positive for patients, with the majority promoting AI regulation through national legislation. 86.1% of DRs and 94.0% of RTTs were favourable to AI implementation. CONCLUSION: This research identifies priority AI development and implementation areas for DRs and RTTs. It thus highlights that DRs and RTTs should be involved in development of AI tools that would best support practice, and that clearly defined pathways for AI implementation into these key professions requires discussion so that optimum use and patient safety can ensue. IMPLICATIONS FOR PRACTICE: Understanding opinions of AI has significant implications for practice, for ensuring optimal product development, implementation, and training, together with planning for potential DR and RTT role changes.

Association of habits, triggers, glycaemic control, routines, stress and impulse control among emerging adults with type 1 diabetes.

AIM: Glycaemic control is known to be poor among emerging adults with type 1 diabetes, but the reasons for this are poorly understood. Examination of diabetes self-management-related habits, triggers and daily routines within the context of impulse control and perceived daily stress may provide increased understanding of glycaemic control during this transitional period. This study examined associations among checking blood glucose (CBG) habits, eating a meal (EAM) habits and glycaemic control within the context of CBG triggers, daily routines, impulse control and perceived daily stress, in emerging adults with type 1 diabetes. METHODS: A cross-sectional convenience sample of 100 emerging adults with type 1 diabetes was recruited from an outpatient diabetes care clinic for this age group. Participants self-reported frequency of CBG and EAM habits, CBG triggers, daily routines, perceived daily stress and impulse control. Glycaemic control values were obtained from medical records. Path analysis was performed. RESULTS: Better glycaemic control was positively and significantly associated with greater frequency of CBG and EAM habits. CBG habits were positively and significantly associated with CBG triggers and EAM habits. EAM habits were positively and significantly associated with daily routines. CONCLUSIONS: We suggest interventional research targeting CBG and EAM habits and daily routines to examine the impact on diabetes self-management and glycaemic control.

SURVEY OF KEY RADIATION SAFETY PRACTICES IN INTERVENTIONAL RADIOLOGY: AN IRISH AND ENGLISH STUDY.

Interventional radiology is a rapidly evolving speciality with potential to deliver high patient radiation doses, as a result high standards of radiation safety practice are imperative. IR radiation safety practice must be considered before during and after procedures through appropriate patient consent, dose monitoring and patient follow-up. This questionnaire-based study surveyed fixed IR departments across Ireland and England to establish clinical practice in relation to radiation safety. Pre-procedure IR patient consent includes all radiation effects in 11% of cases. The patient skin dose surrogate parameter of Kerma to air at a reference point (Kar) is under-reported. Only 39% of respondents use a substantial radiation dose level and inform patients after these have been reached. Poor compliance with unambiguous, readily available best practice guidance was observed throughout highlighting patient communication, patient dose quantification and subsequent patient dose management concerns.

ß-NMR measurements of molecular-scale lithium-ion dynamics in poly(ethylene oxide)-lithium-salt thin films.

ß-detected NMR (ß-NMR) has been used to study the molecular-scale dynamics of lithium ions in thin films of poly(ethylene oxide) (PEO) containing either lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) or lithium trifluoroacetate (LiTFA) salts at monomer-to-salt ratios (EO/Li) of 8.3. The results are compared with previous ß-NMR measurements on pure PEO and PEO with lithium triflate (LiOTf) at the same loading [McKenzie et al., J. Am. Chem. Soc. 136, 7833 (2014)]. Activated hopping of 8Li+ was observed in all of the films above ∼250 K, with the hopping parameters strongly correlated with the ionicity of the lithium salt rather than the polymer glass transition temperature. The pre-exponential factor increases exponentially with ionicity, while the activation energy for hopping increases approximately linearly, going from 6.3±0.2 kJ mol-1 in PEO:LiTFA to 17.8±0.2 kJ mol-1 in PEO:LiTFSI. The more rapid increase in the pre-exponential factor outweighs the effect of the larger activation energy and results in 8Li+ hopping being fastest in PEO followed by PEO:LiTFSI, PEO:LiOTf, and PEO:LiTFA.

Pharmacoeconomic evaluation of flumazenil for routine outpatient EGD.

BACKGROUND: Flumazenil is a benzodiazepine antagonist indicated for reversal of the sedative effects of benzodiazepines. Previous studies suggest that flumazenil may shorten recovery time after endoscopy, but there are few data on actual recovery room times and charges. METHODS: Fifty patients undergoing routine upper endoscopy were sedated with midazolam alone in the usual titrated manner. Patients were randomized in a double-blind fashion to receive either flumazenil or saline immediately after procedure. Assessments of responsiveness, speech, facial expression, and ptosis (Observer's Assessment of Alertness/Sedation [OAA/S] scale) were made before procedure, immediately after procedure and every 15 minutes thereafter. The patient was discharged from the recovery room when vital signs and OAA/S scale reached preprocedure levels. Recovery room times and charges were recorded. RESULTS: The flumazenil group demonstrated shorter recovery room times and recovery room charges than the placebo group (p < 0.001). The difference in recovery room charges was not statistically different when flumazenil charges were included (p = 0.09). CONCLUSIONS: The routine use of flumazenil after midazolam sedation for upper endoscopy significantly shortened recovery time and charges but did not statistically reduce overall charges.

Acquisition of serum isotype-specific and G type-specific antirotavirus antibodies among children in day care centers.

The acquisition of serum antirotavirus antibodies among children in day care centers was monitored through two rotavirus seasons. Twenty-six children were monitored daily for diarrhea and weekly for stool rotavirus excretion through a rotavirus season of infections with serotype G1 and a successive season of infections with both G1 and G3. Sera were collected before and after each rotavirus season and tested for antirotavirus IgA and IgG and for G type-specific blocking antibody. The prevalence of protective serum IgA and IgG titers increased from 36% and 45% before Season 1 to 77% and 96% after Season 2, respectively (P < 0.02 and 0.001). G type-specific antibodies also increased (G1, P < 0.001; G2, P = 0.005; G3, P = 0.003; G4, P = 0.006), including for noncirculating types. Homotypic and heterotypic antibodies increased as the number of rotavirus infections experienced by a child increased. The group of children with two proven infections developed protective isotype-specific and G type-specific antibodies. These results indicate that in first exposures to rotavirus G types, children develop predominantly homotypic antibody. However, as the number of rotavirus infections increase, children develop heterotypic antibody to G types at levels that correlate with broad protection against rotavirus infection and illness, despite exposure to a restricted number of G types.

The effect of dexamethasone on time averaged mean velocity in the middle cerebral artery in very low birth weight infants.

The effect of repeated doses of dexamethasone (0.25 mg/kg/dose every 12 h) on time averaged mean velocity in the middle cerebral artery was assessed in ten ventilated very low birth weight infants requiring treatment with dexamethasone for bronchopulmonary dysplasia or airway obstruction. The infants were studied by colour/duplex Doppler technique prior to the administration of the first and the third dose of dexamethasone, and 10, 30, and 120 min after these doses. Dexamethasone treatment was associated with an improvement in infant lung condition, an increase in mean arterial blood pressure and a decrease in heart rate. The time averaged mean velocity was statistically significantly reduced at 120 min after the first dose. This was not associated with a decrease in PCO2. The observed reduction of 18% from baseline in the time averaged mean velocity is unlikely to be of clinical importance.

Acute gastroenteritis in Latin America.

In Latin America, acute gastroenteritis remains to be an important cause of morbidity in adults and a major cause of morbidity and mortality in children. A child under 5 years of age belonging to a low income segment of the Latin American population will develop 5 to 10 bouts of diarrhea every year. The bacterial and viral enteropathogens associated with acute diarrhea are reviewed in this article. Updated information on epidemiologic, clinical, and pathogenic aspects for the relevant enteropathogens is discussed with special emphasis on regional data when available. The current diarrheogenic E. coli classification is particularly discussed. A diagnostic approach to acute gastroenteritis for both the clinical and research laboratories in Latin America as well as guidelines for treatment are proposed.

A clinician-driven home care delivery system.

The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal.

Outbreaks of human enteric adenovirus types 40 and 41 in Houston day care centers.

OBJECTIVE: Human enteric adenovirus (EAd) types 40 and 41 cause diarrhea in young children, but little is known about their association with outbreaks of diarrhea in the child care setting. This study evaluated EAd as a cause of outbreaks of diarrhea among infants and toddlers in day care centers. DESIGN: Stool specimens were collected weekly regardless of symptoms during four periods from January 1986 to April 1991, from children 6 to 24 months of age enrolled in prospective studies of diarrhea in day care centers. All diarrhea stool specimens were tested for bacterial enteropathogens, rotavirus, and Giardia lamblia. A total of 131 outbreaks occurred during the study. No etiologic agent was identified in 77 outbreaks. Stool specimens from 75 of these 77 outbreaks and from another 21 outbreaks of diarrhea with a known cause were evaluated for EAd with a monoclonal antibody-based enzyme immunoassay. RESULTS: A total of 4402 stool specimens from 613 children from these 96 outbreaks was tested for EAd. The virus was detected in specimens collected during 10 outbreaks, 3 of which occurred in 1986, 3 in 1988, 1 in 1989, 1 in 1990, and 2 in 1991. Of 249 children, 94 (38%) in these 10 EAd outbreaks were infected with EAd. In 51 children (54%) the infection was symptomatic and in 43 (46%) it was asymptomatic. Outbreaks lasted 7 to 44 days (mean 24.5 days). Duration of EAd excretion ranged from 1 to 14 days (mean 3.9 days), with excretion occurring from 7 days (mean 2.6) before diarrhea began to 11 days (mean 5.3 days) after diarrhea stopped. CONCLUSION: Enteric adenovirus types 40 and 41 are an important cause of outbreaks of diarrhea among children attending day care centers, often involve children in more than one room, and frequently produce asymptomatic infection.

Use of albumin in a university hospital: the value of targeted physician intervention.

Results of a preliminary study of albumin use at the University of Michigan Hospital were shared with one surgical service (thoracic surgery) that had a documented high rate of inappropriate use. To determine the effectiveness of this targeted educational intervention in reducing inappropriate use and associated drug costs, albumin prescribing for all adult inpatients at University Hospital over a 30-day period was assessed in a retrospective review. Eighty-six patients used a total of 843 units, a ten percent reduction in total albumin use. Albumin administration to thoracic surgery patients decreased by 38 percent. The 35 percent reduction in inappropriate albumin use by this service (Fisher's exact test, p less than 0.001) was associated with an estimated annual cost savings of +83,500. Inappropriate albumin use by other medical services generally increased over previously measured levels. This study demonstrated the effectiveness of targeted educational interventions in reducing inappropriate albumin use and thereby controlling rising healthcare costs.

Development and funding of a pharmacy-based investigational drug service.

The development, implementation, and operation of a pharmacy-based investigational drug service (IDS) at a university medical center are described. Before the IDS was established, pharmacy participation in investigational drug research was limited to the preparation of novel dosage forms. Medication errors, improper storage and labeling, and inadequate inventories of investigational drugs were common problems. Stepped-up enforcement by FDA and the National Cancer Institute (NCI) of guidelines for investigational drug control prompted the formation of a multidisciplinary task force, which recommended that the department of pharmaceutical services expand its support of investigational drug studies to include inventory control, record keeping, and clinical services. The IDS is supported by both the hospital and the school of medicine and currently receives 36% of its funding from principal investigator grants and contracts. The IDS coordinates more than 100 study protocols and dispenses more than 4000 doses of investigational drugs annually. The IDS is staffed by 1.0 full-time equivalent (FTE) clinical pharmacist and 0.5 FTE technician. Inventory control and billing functions are performed by a departmental microcomputer system. The IDS has demonstrated a positive gross margin for each of its first two years of operation. Problems associated with the control and use of investigational drugs at this institution have been successfully corrected by the implementation of a pharmacy-based IDS.