Managing acoustic noise within MRI: A qualitative interview study among Swedish radiographers.

INTRODUCTION: Acoustic noise from magnetic resonance imaging (MRI) can cause hearing loss and needs to be mitigated to ensure the safety of patients and personnel. Capturing MR personnel's insights is crucial for guiding the development and future applications of noise-reduction technology. This study aimed to explore how MR radiographers manage acoustic noise in clinical MR settings. METHODS: Using a qualitative design, we conducted semi-structured individual interviews with fifteen MR radiographers from fifteen hospitals around Sweden. We focused on the clinical implications of participants' noise management, using an interpretive description approach. We also identified sociotechnical interactions between People, Environment, Tools, and Tasks (PETT) by adopting a Human Factors/Ergonomics framework. Interview data were analyzed inductively with thematic analysis (Braun and Clarke). RESULTS: The analysis generated three main themes regarding MR radiographers' noise management: (I) Navigating Occupational Noise: Risk Management and Adaptation; (II) Protecting the Patient and Serving the Exam, and (III) Establishing a Safe Healthcare Environment with Organizational Support. CONCLUSION: This study offers insights into radiographers' experiences of managing acoustic noise within MRI, and the associated challenges. Radiographers have adopted multiple strategies to protect patients and themselves from adverse noise-related effects. However, they require tools and support to manage this effectively, suggesting a need for organizations to adopt more proactive, holistic approaches to safety initiatives. IMPLICATIONS FOR PRACTICE: The radiographers stressed the importance of a soundproofed work environment to minimize occupational adverse health effects and preserve work performance. They acknowledge noise as a common contributor to patient distress and discomfort. Providing options like earplugs, headphones, mold putty, software-optimized "quiet" sequences, and patient information were important tools. Fostering a safety culture requires proactive safety efforts and support from colleagues and management.

Incident reporting and level of MR safety education: A Danish national study.

INTRODUCTION: MR-safety remains a concern among MR professionals. We aimed to evaluate the extent of MR-related incidents using a national database and a questionnaire among MR professionals and to identify possible predictors for MR-related incidents. METHODS: MR-related incidents reported to a national database from 2015 to 2017 were scrutinized. A national online survey focussing on MR safety and education was performed. Quantitative analyses, descriptive statistics and regression analyses were used. RESULTS: The database included 196, 97 and 100 direct MR-related incidents in 2015, 2016 and 2017, respectively. Regarding the questionnaire, 208 MR professionals responded. Within the last year, 33% had been involved in an MR-related incident that was reported in the national database. At some time in their working life, 53% had been involved in an MR-related incident that was reported, but 25% had been involved in an incident that was not reported. The responses to the questionnaire reflected far more incidents than those reported to the database for all categories. Sixty-one percent of respondents indicated that external personnel in the MR environment are a safety risk. External personnel in the MR environment were found to be a predictor for reported and unreported MR-related incidents with odds ratio (OR) = 2.07; p = 0.033 and OR = 5.17; p = 0.0005 respectively. CONCLUSION: There seems to be severe underreporting of MR-related incidents. External personnel in the MR-environment and scanning patients in anaesthesia were found to be predictors for both reported and unreported MR-related incidents. Regulations regarding the minimum required MR safety education of different groups of MR professionals and external personnel are recommended. IMPLICATIONS FOR PRACTICE: Enforcing MR safety education and highlighting the importance of MR safety within hospital organisations would contribute to better patient and personnel safety.

Chronic infection. Hidden costs of infection: chronic malaria accelerates telomere degradation and senescence in wild birds.

Recovery from infection is not always complete, and mild chronic infection may persist. Although the direct costs of such infections are apparently small, the potential for any long-term effects on Darwinian fitness is poorly understood. In a wild population of great reed warblers, we found that low-level chronic malaria infection reduced life span as well as the lifetime number and quality of offspring. These delayed fitness effects of malaria appear to be mediated by telomere degradation, a result supported by controlled infection experiments on birds in captivity. The results of this study imply that chronic infection may be causing a series of small adverse effects that accumulate and eventually impair phenotypic quality and Darwinian fitness.

Effect assessment in work environment interventions: a methodological reflection.

This paper addresses a number of issues for work environment intervention (WEI) researchers in light of the mixed results reported in the literature. If researchers emphasise study quality over intervention quality, reviews that exclude case studies with high quality and multifactorial interventions may be vulnerable to 'quality criteria selection bias'. Learning from 'failed' interventions is inhibited by both publication bias and reporting lengths that limit information on relevant contextual and implementation factors. The authors argue for the need to develop evaluation approaches consistent with the complexity of multifactorial WEIs that: a) are owned by and aimed at the whole organisation; and b) include intervention in early design stages where potential impact is highest. Context variety, complexity and instability in and around organisations suggest that attention might usefully shift from generalisable 'proof of effectiveness' to a more nuanced identification of intervention elements and the situations in which they are more likely to work as intended. STATEMENT OF RELEVANCE: This paper considers ergonomics interventions from perspectives of what constitutes quality and 'proof". It points to limitations of traditional experimental intervention designs and argues that the complexity of organisational change, and the need for multifactorial interventions that reach deep into work processes for greater impact, should be recognised.

Hepatitis A vaccination by intracutaneous low dose administration: a less expensive alternative.

We investigated the immune response to three different intracutaneous (i.c.) doses of inactivated hepatitis A vaccine: 72, 144, and 216 ELISA units (EU). The response was measured using a quotient score derived from a commercial enzyme-linked immunosorbent assay (HAVAB Abbott) and translated to IU per liter using a World Health Organization standard serum for hepatitis A virus antibody. The results were compared with the results obtained after an intramuscular (i.m.) full dose, i.e. 1,440 EU, at 0 and 6-12 months. As estimated from antibody concentration, 3 lots of 144 EU i.c. with 100% or two lots of 216 EU i.c. with 98% seroconversion results in at least as good early protection as the standard immunization with one lot of 1,440 EU i.m., (79% with our method). Indeed, only two doses of 144 EU vaccine (90% seroconversion) seem to give results comparable to the standard procedure. After the booster dose the median antibody concentration is 1,290 IU/l for the 144 EU vaccine and 837 for the 216 EU one, compared with an antibody response of 990 IU/l for the standard 1,440 EU i.m. vaccination. In conclusion, three doses of 144 EU vaccine i.c. or, as an alternative, two doses of 216 EU at monthly intervals give good early protection (e.g. before travel). After the booster dose, which is given 6 months to 1 year later, the serological response is comparable to the standard procedure of two doses of the 1,440 EU vaccine given i.m. and with 100% seroconversion in all three programs.

Quality of life: status and change (QLsc) reliability, validity and sensitivity of a generic assessment approach tailored for diabetes.

The aim was to review the psychometric properties of a generic strategy for assessing status and change in quality of life (QLsc) partly tailored for patients with insulin-dependent diabetes mellitus. Quality of life was defined as perceived well-being and life satisfaction, globally as well as within key domains and functions. The strategy has been developed iteratively and, thereby, proven psychometrically satisfactory across groups and settings. Seventy-three consecutive outpatients were examined in 1988, after a period on multiple injection treatment by insulin pen; 66 were re-examined in 1990. In 1988 and 1990, perceived well-being and life domain status were self-rated. Life domain changes attributed to pen treatment were rated retrospectively in 1988 and subsequent general changes over 2 years rated similarly in 1990. Shortened parallel ratings were performed by significant others. Series of cross-sectional and longitudinal analyses yielded convincing reliability, validity and sensitivity evidence of various kinds for all ratings, irrespective of rater-self or significant other. As expected, a consistent correlational pattern emerged between status self-ratings, suggesting 'the better/worse off' in one sense, the 'better/worse off' in other senses assessed. Moreover, congruent change linkages, suggesting 'the greater change for the better/worse' according to the one type, the 'greater change for the better/worse' according to the other one, were also salient. Fourteen persons with less congruence in the disparate, but parallel change rating parameters appeared to be in a critical disease phase, applying reaction formation or denial like defence mechanisms. In conclusion, the entire cohesive strategy also functioned well in the current setting. It may probably be applied in search for other vulnerable sub-groups and in analyses of coping strategies. It offers rich analytic options especially in evaluational contexts. The study outcome may stimulate development of methodology within this field.

Repeated short-term sick-leave and quality of life. An evaluation of a clinical socio-medical intervention.

The primary aim of this study was to evaluate a clinical socio-medical supportive program for repeated short-term sickleavers who exhibited no evident reason for their prolonged absence. Attention was drawn to changes in the quality of life of the participants. Ninety-nine persons took part in the full program. The sex distribution was even and the mean age was 32 years. The average number of days of sick-leave during the year preceding the entrance into the program was 28. The most common self-stated diagnosis was upper respiratory infection or gastro-intestinal problems. The evaluation showed a significant change for the better in the quality of life and well-being of the patients, although more than every other patient did not explicitly attribute any personal benefit to the intervention itself. The results coincide irrespective of measuring method and, are by and large, consistent over most areas of life and components of well-being assessed. Thus the design and the results of the evaluation look very promising concerning reliability, validity and especially sensitivity. A corresponding model may be applicable more generally when evaluating health- and medical care.