Facilitators and barriers to undertaking research into the practice and delivery of clinical ultrasound: A qualitative investigation.

INTRODUCTION: Increasing research productivity of clinicians can deliver benefits for healthcare organisations and those who work in them, but a notably larger proportion of ultrasound practitioners are interested in undertaking research than are actively engaged in it. This study aimed to understand this gap by investigating the facilitators and barriers to conducting research in professionals from multiple disciplines whose work is focused on clinical ultrasound. METHODS: Current and prospective researchers from any discipline interested in or undertaking research into the practice and delivery of clinical ultrasound were recruited between March and June 2023. Participants completed semi-structured qualitative interviews with a researcher via video platform. Data were analysed using reflexive thematic analysis. RESULTS: Twelve participants (8 women, 4 men) from a range of disciplines participated. Five themes were identified, which were: 1) research is a challenging path, 2) interpersonal networks fuel research, 3) research requires resources, 4) data collection challenges and 5) scientific curiosity. These suggested that 1) participants experienced research as a challenging career path; 2) formal and informal networks provided important knowledge and opportunities; 3) research was a resource-intensive activity, requiring time and funding, and other professional/clinical commitments often took priority; 4) data collection and applying for ethical approval were barriers requiring specialist knowledge to overcome; and 5) personal scientific curiosity and desire for achievement were key drivers motivating participants to continue in research. CONCLUSIONS: Motivation for engaging in ultrasound research activity was mainly internal. Additional barriers and facilitators were external, including time, information and interpersonal networks. IMPLICATIONS FOR PRACTICE: Organisations can increase the likelihood of research activity by ultrasound practitioners by providing allocated research time and social support networks. It may be particularly fruitful to focus on helping prospective researchers bridge the gap between 'novice' and 'beginner' phases.

Managing the unmanageable: A qualitative study exploring sonographer experiences of and training in unexpected and difficult news delivery.

INTRODUCTION: Ultrasound is used to diagnose pregnancy complications such as miscarriage and fetal health conditions. Within the UK, findings identified during ultrasound examination are delivered by sonographers as standard. However, little is known about the experiences of sonographers when delivering unexpected news (DUN), the impact this has on them, or their preferences for training on news delivery. METHODS: Qualitative interviews were completed with fourteen sonographers and were analysed using an inductive thematic approach. Key themes were identified. RESULTS: Participants said that obstetric ultrasound often involves 'managing' the patient encounter, including: navigating (unrealistic) patient expectations; handling their own responses to unexpected findings; and managing interaction by moderating emotional expression and communication practices to deliver patient-centred and empathic care. Persistent uncertainty of outcomes, prognosis and patient reactions, alongside high workloads, and frequent siloed working, makes DUN challenging for sonographers. DUN was experienced as emotionally burdensome, and sonographers employed personal coping strategies to reduce stress/burnout. However, the greatest mitigation for stress/burnout was support from peers, though accessing this was challenging. Peers were also described as key sources of learning, especially through observation. CONCLUSION: Challenges associated with DUN are an enduring experience for sonographers. Facilitating regular ongoing support and training would enable sonographers to cope with negative aspect of the role, including the emotional burden of DUN. IMPLICATIONS FOR PRACTICE: Long patient lists are prioritised to deal with high demand for services. However, sonographer wellbeing needs to be a key priority to avoid stress and burnout. This means facilitating protected time to access support from colleagues, multidisciplinary working where possible, and regular access to training to support DUN. Training focusing on communication practices, alongside dealing with emotional burdens of the role would be beneficial.

Immunoanalysis of ultraviolet radiation induced DNA damage and repair within specific gene segments of plasmid DNA.

The region-specific heterogeneity of repairing DNA damage has been established in several biological systems. A flexible and sensitive approach, based upon DNA damage specific antibodies, is described to monitor the repair of specific lesions within discrete genomic segments. Membrane transblotted DNA restriction fragments are immunoanalyzed for the initial formation and repair of 254 nm radiation induced pyrimidine dimers. Sensitivity of dimer immunodetection increases proportional to fragment concentration and size. Antibody binding was detectable in a 0.5 kb fragment obtained from approx. 100 ng of restriction digested phage lambda DNA irradiated with 50 J m-2. Dimers within larger fragments (greater than 5 kb) could be detected at ultraviolet doses as low as 1 to 2 J m-2. To determine the occurrence of preferential repair in prokaryotic cells, damage was assessed in DNA sequences established in various Escherichia coli strains. In vivo repair of 8.9 kb vector and 6.4 and 3.2 kb gene inserts occurred with an approximate t1/2 of 45 min in UvrABC excision repair-proficient strains. Antibody binding sites were retained by DNA within repair-deficient strains. Compared to UvrABC, the repair of DNA fragments mediated by T4 endonuclease V was rapid and complete within 30 min of cellular irradiation. The efficient repair in DenV+ strain is attributable to a highly processive repair enzyme rather than to selective repair of actively replicating target genes. The results demonstrate the exceptional ability of antibodies specific for altered biomolecular lesions to map damage and repair in gene segments episomally established within cells.

Induction and processing of promutagenic O4-ethylthymine lesion in specific gene segments of plasmid DNA.

High affinity antibodies were used for the quantitative assessment of the miscoding O4-ethylthymine (O4-EtThy) base lesion in nanogram amounts of membrane transblotted restriction fragments of ENU treated DNA. The polyclonal antibody (TB3) specifically recognized attomoles of the alkylation adducts in modified DNA with no cross-reactivity to an excess of unmodified DNA. The sensitivity of the immuno-quantitative method was determined to be in the range of 76 attomoles to 2.43 fmol, corresponding to 0.24 x 10(-7) to 7.9 x 10(-7) adducts per nucleotide in plasmid DNA. Modification levels in ras and tk genes were estimated as 0.025 and 0.014 adducts respectively. Specific antibody binding was proportional to the dose of ENU and size of the DNA fragments. In differentially ethylated ras gene, the amount of O4-EtThy was quantified as 0.026, 0.08 and 0.13 adducts per gene fragment. A DNA concentration dependent antibody binding was observed with large (23.13 and 9.41 kb) and smaller (2.02 kb) fragments of HindIII digested ENU treated phage lambda DNA. To monitor the repair of O4-EtThy lesions in specific segments, damage was assessed in sequences of plasmid DNA established in various Escherichia coli strains. The loss of antibody binding to O4-EtThy adducts in ethylated DNA fragments of 6.4 kb ras gene and 3.6 kb tk gene occurred with an approximate t1/2 of 45 and 35 min, respectively, in the repair proficient wild type E. coli. On the contrary, no repair was seen in the alkyltransferase deficient double mutant ada-ogt- strain. The results specifically demonstrate the sensitivity of the immunological technique and the unique ability of the O4-EtThy specific antibodies to scan this promutagenic base lesion and its repair in very small amounts of selected gene segments in DNA.