Radiology image interpretation services in a low-resource setting: Medical doctors' experiences and the potential role of radiographers.

INTRODUCTION: Medical doctors can encounter significant challenges in both the radiology image interpretation service and their ability to interpret images to promote effective patient management. This study aimed to explore the experiences of medical doctors in a low-resource setting regarding the image interpretation service received in state-funded hospitals and the potential role of radiographers. METHODS: A qualitative approach with a descriptive phenomenology design was employed. Thirteen medical officers and medical interns, with a maximum of three years of experience, were purposively selected from three state-funded hospitals. Semi-structured interviews were conducted in English, and data analysis followed the conventional content analysis method using Atlas.ti for Windows (version 9). RESULTS: Three main themes emerged from the data. The first theme was a poor image interpretation service which highlighted issues such as long turnaround times for image reporting and compromised patient management. The second theme was training and support deficiency which revealed the inadequacy of image interpretation training and the need for additional on-the-job support. The third theme was the inconspicuous radiographer role which showcased the potential opportunities for radiographers to aid in filling the gaps in the image interpretation system. CONCLUSION: Medical doctors in this low-resource setting experience significant delays in radiology image interpretation, leading to compromised patient management. Their training in image interpretation is inadequate, and they often lack on-the-job support. Radiographers potentially play a role in image interpretation which may provide solutions to these contextual challenges. IMPLICATIONS FOR PRACTICE: There is a need to review and develop a comprehensive image interpretation system that effectively supports medical doctors in image interpretation, possibly involving the collaboration of radiographers.

Knowledge of computed tomography dose optimisation and justification among CT users and referring physicians: A single hospital study.

INTRODUCTION: Radiation dose associated with computed tomography (CT) remains a concern, and radiation risk does not receive the needed attention, especially in low and middle-income countries. This because the frequency of this high-dose examination is rapidly growing and systems for protocol optimisation and dose justification are yet to be provided in CT imaging. OBJECTIVE: To determine radiographers' and radiologists' awareness and knowledge of CT dose optimisation. We also determined knowledge of dose justification and use of the referral guidelines amongst the referring physicians. METHODS: Radiographers and radiologists were invited to complete a web-based questionnaire whilst the referring physicians completed a self-administered questionnaire. The returned questionnaires were analysed and a significant difference was determined using Yates corrected Chi-square, and a p-value of 0.05 was considered at the 95% confidence interval. RESULTS: The response rates were 50% (17 out 34) and 35% (16 out 46) for radiographers and radiologists respectively while referring physicians had a response rate of 84% (92 out of 110). Overall, more radiographers (47.1%) than radiologists (18.8%) had good knowledge of CT doses and image quality, however, the difference in knowledge was not found to be significant (p = 0.167). In addition, knowledge of diagnostic reference levels (DRLs) was significantly (p = 0.033) higher amongst radiographers (52.9%) as compared to radiologists (12.5%). Meanwhile, physicians understood the principles of dose justification. However, their knowledge of referral guidelines was limited. CONCLUSION: The study revealed that radiographers were more knowledgeable on matters relating to radiation dose and image quality as well as DRLs when compared to radiologists. Meanwhile, the concept of dose justification was understood among physicians, however, they had limited awareness and knowledge of referral guidelines.

Radiographers' experiences of image interpretation training in a low-resource setting.

INTRODUCTION: Radiographers extend their roles through formal and on-the-job training to keep up with clinical practice changes. One area of role extension that is now incorporated into undergraduate programmes is image interpretation, although the training provided may vary between institutions. This study explored the experiences of graduates from one higher education institution in a low-resource context with regard to their image interpretation training. METHODS: A qualitative phenomenological research design was employed to investigate the experiences of ten radiography graduates who were purposively selected from one higher education institution. Individual semi-structured interviews were conducted with each participant after obtaining their informed consent. The interview recordings were transcribed and analysed using Atlas.ti Windows (Version 9.0) software, following Colaizzi's seven-steps of data analysis. RESULTS: From the ten interviews conducted, teaching approach, clinical education, and assessment strategy emerged as areas of experience within the teaching and learning theme, while practitioner role modelling, skill utilisation, and industry impact were sub-themes under the paradoxical reality theme. The participants' experiences indicated a theory-practice gap in image interpretation among radiographers. CONCLUSION: The participants' experiences reflected a misalignment in the educational process due to inadequacies in the teaching approach, clinical education, and assessment strategies. Participants encountered significant differences between their expectations and clinical realities during and after training. Image interpretation by radiographers was recognised as a relevant area for role extension in this low-resource setting. IMPLICATIONS FOR PRACTICE: While these findings are specific to the experiences of the participants, conducting similar research in comparable contexts and implementing competency-based image interpretation assessments could help identify gaps and guide interventions to address shortcomings.

Radiography lecturers' understanding of a socially responsive curriculum.

INTRODUCTION: In health professions education (HPE), focus is placed on developing clinically competent practitioners who can function within their professional scope in a broad range of health care contexts. In this study, the authors investigated diagnostic radiography lecturers' understanding of how students become socially responsive. The concept of 'critical consciousness' was explored as an intervention of being a transformer in the local environment. This places focus on learning and teaching that aims to develop radiography graduates who are critically conscious, such that they can take up the challenges of healthcare in their environment, in addition to being clinically competent in their field. The study under discussion therefore sought to find out how radiography lecturers understand a socially responsive curriculum at a University of Technology in the South African context. METHOD: A qualitative, exploratory design was used where curriculum documents were reviewed and from which stimulus points were identified for a semi-structured focus group interview with radiography lecturers followed by five individual interviews. All interviews were audio-recorded, transcribed, coded and analysed through a process of thematic analysis. RESULTS: Four dominant themes emerged from the analysis, namely i) diverse understandings of critical consciousness, ii) becoming a reflective practitioner, iii) a need for curriculum transformation and iv) emerging pedagogies. CONCLUSION: Critical reflection by both the radiography students and lecturers is key to developing social awareness and critical consciousness which could drive critical motivation and critical action to effect social change. It is recommended that the current curriculum should be reviewed and transformed to include constructive reflective practice. IMPLICATIONS FOR PRACTICE: Dedicated time should be scheduled, in the curriculum, to allow students and lecturers to engage in meaningful constructive reflection to enhance socially responsive practice.

COVID-19 and tobacco cessation: lessons from India.

OBJECTIVES: The Government of India prohibited the sale of tobacco products during the COVID-19 lockdown to prevent the spread of the SARS-CoV-2 virus. This study assessed the tobacco cessation behaviour and its predictors among adult tobacco users during the initial COVID-19 lockdown period in India. METHODS: A cross-sectional study was conducted with 801 adult tobacco users (both smoking and smokeless tobacco) in two urban metropolitan cities of India over a 2-month period (July to August 2020). The study assessed complete tobacco cessation and quit attempts during the lockdown period. Logistic and negative binomial regression models were used to study the correlates of tobacco cessation and quit attempts, respectively. RESULTS: In total, 90 (11.3%) tobacco users reported that they had quit using tobacco after the COVID-19 lockdown period. Overall, a median of two quit attempts (interquartile range 0-6) was made by tobacco users. Participants with good knowledge on the harmful effects of tobacco use and COVID-19 were significantly more likely to quit tobacco use (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.2-4.0) and reported more quit attempts (incidence risk ratio 5.7; 95% CI 2.8-11.8) compared to those with poor knowledge. Participants who had access to tobacco products were less likely to quit tobacco use compared to those who had no access (OR 0.3; 95% CI 0.2-0.5]. CONCLUSIONS: Access restrictions and correct knowledge on the harmful effects of tobacco use and COVID-19 can play an important role in creating a conducive environment for tobacco cessation among users.

In-vitro antibacterial and anti-encrustation performance of silver-polytetrafluoroethylene nanocomposite coated urinary catheters.

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections, leading to increased morbidity and mortality. A major reason for this is that urinary catheters are not yet capable of preventing CAUTIs. AIM: To develop an anti-infective urinary catheter. METHODS: An efficient silver-polytetrafluoroethylene (Ag-PTFE) nanocomposite coating was deposited on whole silicone catheters, and two in-vitro bladder models were designed to test antibacterial (against Escherichia coli) and anti-encrustation (against Proteus mirabilis) performances. Each model was challenged with two different concentrations of bacterial suspension. FINDINGS: Compared with uncoated catheters, coated catheters significantly inhibited bacterial migration and biofilm formation on the external catheter surfaces. The time to develop bacteriuria was an average of 1.8 days vs 4 days and 6 days vs 41 days when the urethral meatus was infected with 106 and 102 cells/mL, respectively. For anti-encrustation tests, the coated catheter significantly resisted encrustation, although it did not strongly inhibit the increases in bacterial density and urinary pH. The time to blockage, which was found to be independent of the initial bacterial concentration in the bladder, was extended from 36.2±1.1 h (uncoated) to 89.5±3.54 h (coated) following bacterial contamination with 103 cells/mL in the bladder. Moreover, the coated catheter exhibited excellent biocompatibility with L929 fibroblast cells. CONCLUSION: Ag-PTFE coated Foley catheters should undergo further clinical trials to determine their ability to prevent CAUTIs during catheterization.

Computed tomography dose index for head CT in northern Nigeria.

Computed tomography dose index w and dose length product were recorded for the purpose of developing diagnostic reference levels (DRLs) for radiation dose optimisation. The study was conducted in three radiology departments with CT centres in Northern Nigeria. Data were collected from 54 consenting adult participants (weighing 70 kg ± 3) that had head CT scans. Analysis was done using SPSS version statistical software. A combined dose for the three centres was calculated and compared with the reported data from the international communities where there are established DRLs. Third quartile values of CTDIw and DLP were determined as 77 mGy and 985 mGy cm, respectively. Local DRLs that are significantly higher than most of the reported data in the literature have been established.

Basic rules for polarised cell growth.

Growth by cell elongation is a morphological process that transcends taxonomic kingdoms. Examples of this polarised growth form include hyphal tip growth in actinobacteria and filamentous fungi and pollen tube development. The biological processes required to produce polarisation in each of these examples are very different. However, commonality of the polarised growth habit suggests that certain "basic physical rules" of development are being followed. In this paper we are concerned with trying to further elucidate some of these basic rules. To this end, we focus on a simple and hence ubiquitous description of the polarised cell, its geometry, and using a mathematical model investigate how geometry and the deposition of new wall material could be related. We show that this simple model predicts both cell geometry and the location of maximal wall-deposition in a range of examples.

Stroke history and Chagas disease are independent predictors of silent cerebral microembolism in patients with congestive heart failure.

BACKGROUND: Chagas disease is endemic in South and Central America, where 18 million individuals are infected by Trypanosoma cruzi, causing congestive heart failure (CHF) and cardioembolic stroke. Transcranial Doppler (TCD) is able to detect real-time microembolic signals (MES) to the brain vessels and may represent a surrogate marker of stroke risk. We aimed to determine predictors of MES in a population of patients with CHF. METHODS: Consecutive CHF patients from a university-based cardiomyopathy clinic underwent TCD recording of the middle cerebral artery for 60 min by a single investigator who was blinded to all clinical data including cardiomyopathy etiology. Predictors of MES were sought by multivariable logistic regression analysis. RESULTS: From April 2004 to February 2009, 144 patients were studied, including 62 (44.6%) patients with Chagas disease. MES were detected in 9 (6.2%) patients and were more frequent in patients with Chagas disease than in patients with other causes of CHF (12.9 vs. 1.2%, p = 0.005). In multivariate analysis corrected for age and left-ventricular ejection fraction, predictors of MES were Chagas disease (odds ratio = 1.15, 95% confidence interval = 1.05-1.26, p = 0.004) and stroke history (odds ratio = 1.27, 95% confidence interval = 1.08-1.50, p = 0.005). CONCLUSIONS: Chagas disease and stroke history are risk factors for MES independent of cardiac disease severity. Other mechanisms besides structural cardiac disease may be operative, increasing embolic risk in Chagas disease.

Human immunodeficiency virus 1 subtypes detected in Scottish blood donors.

The aim of our study was to determine human immunodeficiency virus 1 subtypes in Scottish blood donors. We were able to document virus subtypes present in this population over a period of 19 years and examine associated risk factors where available. Subtype B was found to be the predominant cause of human immunodeficiency virus 1 infection in Scottish blood donors with subtype C increasing in this population after 2002. Non-B subtypes were found mainly in heterosexuals but also in all other risk categories with the exception of men having sex with men (MSM). Within Scotland there is an increase in transmission via heterosexual contact and the consequential introduction of non-B subtypes.

Validation of the National Institutes of Health Stroke Scale, modified Rankin Scale and Barthel Index in Brazil: the role of cultural adaptation and structured interviewing.

BACKGROUND: We aimed to validate three widely used scales in stroke research in a multiethnic Brazilian population. METHODS: The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) were translated, culturally adapted and applied by two independent investigators. The mRS was applied with or without a previously validated structured interview. Interobserver agreement (kappa statistics) and intraclass correlation coefficients were calculated. RESULTS: 84 patients underwent mRS (56 with and 28 without a structured interview), 57 BI and 62 NIHSS scoring. Intraclass correlation coefficient was 0.902 for NIHSS and 0.967 for BI. For BI, interobserver agreement was good (kappa = 0.70). For mRS, the structured interview improved interobserver agreement (kappa = 0.34 without a structured interview; 0.75 with a structured interview). CONCLUSION: The NIHSS, BI and mRS show good validity when translated and culturally adapted. Using a structured interview for the mRS improves interobserver concordance rates.

Detection of HTLV-I and -II in Scottish blood donor samples and archive donations.

BACKGROUND AND OBJECTIVES: Positive samples identified during routine serological screening for HCV (hepatitis C virus), HBV (hepatitis B virus) and HIV (human immunodeficiency virus) are confirmed by nucleic acid testing in the SNBTS (Scottish National Blood Transfusion Service) PCR Reference laboratory. Serological screening for HTLV-I (human T-cell lymphotropic virus type I) and -II was implemented in Scotland in November 2002, at which time a PCR assay was not available for confirmation. Our aim was to develop a real-time PCR assay that could be used for the confirmation of samples showing HTLV-I serological positive or indeterminate reactivity and to investigate whether a serologically silent carrier status exists ('Tax' only) in the Scottish donor population. MATERIALS AND METHODS: A real-time HTLV PCR was devised using a lymphoblastoid cell line which has HTLV-I sequence integrated in the genome (C8166 cells). These were spiked into peripheral blood mononuclear cells. The assay was evaluated on archived serologically confirmed HTLV-positive samples and new positives identified since implementation of screening. RESULTS: HTLV-I and -II were detected in cells and plasma from stored donations and a serological positive donation identified in routine screening. HTLV DNA can also be amplified from the plasma obtained from plasma preparation tubes. There was no evidence of a carrier status ('Tax' only) in 100 serologically negative blood donors tested. The PCR assay developed is reliable and sensitive, capable of identifying one copy of HTLV-I. CONCLUSIONS: The HTLV PCR is a useful addition for HTLV confirmation, especially in serologically indeterminate samples and for look-back studies. HTLV PCR confirmation will provide additional useful information for donor medical staff for counselling donors.

Changing rooms: time for a makeover.

This study explores the concerns expressed by primary school children and their parents about changing arrangements for PE at school. In 39% of schools pupils had expressed anxieties. Are traditional arrangements where children get changed for PE in mixed sex classrooms still appropriate in view of the younger age at which children are now starting puberty?

Detection of HCV and HIV-1 antibody negative infections in Scottish and Northern Ireland blood donations by nucleic acid amplification testing.

BACKGROUND AND OBJECTIVES: To reduce the risk of transfusion-transmissible viruses entering the blood supply, the nucleic acid amplification testing (NAT) was implemented to screen Scottish and Northern Irish blood donations in minipools. After 5 years of NAT for hepatitis C virus (HCV) and 2 years for human immunodeficiency virus-1 (HIV-1), the yield of serologically negative, nucleic acid positive 'window donations' and cost-benefit of NAT is under review. MATERIALS AND METHODS: When the Scottish National Blood Transfusion Service (SNBTS) implemented NAT in 1999, a fully automated 'black box' system was not available. Therefore, an 'in-house' assimilated NAT assay was developed, validated and implemented. The system is flexible and allows testing for additional viral markers to be introduced with relative ease. RESULTS: The HCV and HIV NAT assays have 95% detection levels of 7.25 IU/ml and 39.8 IU/ml, respectively, as determined by probit analysis. One HCV (1 in 1.9 million) and one HIV (1 in 0.77 million) window donation have been detected in 5 and 2 years, respectively, of NAT. CONCLUSION: The SNBTS NAT assays are robust and have performed consistently over the last 5 years. The design of the in-house system allowed HIV NAT to be added in 2003 at a relatively small additional cost per sample, although for both assays, the royalty fee far exceeds the cost of the test itself. Clearly NAT has a benefit in improving the safety of the blood supply although the risks of transfusion-transmitted viral infections, as reported in the Serious Hazards of Transfusion (SHOT) report, are extremely low. Also, in UK the yield of HCV antibody negative, NAT positive donations is far lower than predicted although the early detection of an HIV window period donation and the increase of HIV in the blood donor and general populations may provide a stronger case for HIV NAT. SUMMARY SENTENCE: The yield of HCV and HIV NAT in UK is significantly less than that anticipated from statistical models.

Hepatitis B virus genotypes and precore mutations in Scottish blood donors.

BACKGROUND AND OBJECTIVES: This study was carried out to determine the frequency of hepatitis B virus (HBV) core promoter variants (nucleotide positions 1762, 1764) and precore variants (nucleotide position 1896) in hepatitis B surface antigen (HBsAg)-positive Scottish blood donors. HBV genotypes present in this population were also identified. MATERIALS AND METHODS: A total of 85 HBsAg-positive blood donor samples were included in the study. Of these, 79 were polymerase chain reaction (PCR) positive and had sequence and mutation information. They were divided into two groups: group 1 (23 individuals) were hepatitis B e antigen (HBeAg)-positive and negative for antibody to HBe (anti-HBe); and group 2 (56 individuals) were HBeAg negative and positive for anti-HBe. A line probe assay was used to detect mutations, and a comparison was made by using direct sequence analysis. A different line probe assay was used to identify HBV genotype. RESULTS: The frequencies of mutations in group 1 were 22% each for mutations 1762, 1764 and 1896, increasing to 26%, 35% and 55% in group 2, respectively. By contrast, direct sequence analysis failed to identify 70% of wild-type/mutant mixes. The prevalence of viral genotypes was 41% for genotype A, 12% for genotype B, 5% for genotype C, 30% for genotype D and 12% for mixed-genotype infections. Precore mutations were seen in 10%, 88%, 25% and 74% of genotypes A, B, C and D, respectively. CONCLUSIONS: The results indicate that core promoter and/or precore mutants may be under-reported. The combination of HBV PCR and line probe assays is useful for supplementing HBV serological tests. Non-Caucasian genotypes are present in the UK blood-donating population and will therefore affect the demographics of HBV infection.

Effects of periodic input on the quasi-steady state assumptions for enzyme-catalysed reactions.

In this paper we investigate the validity of a quasi-steady state assumption in approximating Michaelis-Menten type kinetics for enzyme-catalysed biochemical reactions that are subject to periodic substrate input.

Investigation of frequency of active Borna disease virus infection in Scottish blood donors.

BACKGROUND AND OBJECTIVES: Borna disease virus (BDV) can infect a wide range of vertebrate species causing neurological disease. In order to ensure the safety of blood supplies, it is essential to monitor blood for emerging pathogens. MATERIALS AND METHODS: One-hundred individual white cell pellets and pools representing 25 000 plasma donations from human blood were screened for BDV by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: BDV RNA was not detected in any of the samples. CONCLUSIONS: The results indicate that BDV is not widely spread in the UK human population and does not represent a risk as a transfusion-transmitted agent.

Angle-dependence and reproducibility of dual-beam vector doppler ultrasound in the common carotid arteries of normal volunteers.

Dual-beam vector Doppler has the potential to improve peak systolic blood velocity measurement accuracy by automatically correcting for the beam-flow Doppler angle. Using a modified linear-array system with a split receive aperture, we have assessed the angle-dependence over Doppler angles of 40 degrees -70 degrees and the reproducibility of the dual-beam blood maximum velocity estimate measured in the common carotid arteries (CCA) 1 to 2 cm prior to the bifurcation of 9 presumed-healthy volunteers. The velocity magnitude estimate was reduced by approximately 7.9% as the angle between the transmit beam and the vessel axis was increased from 40 degrees to 70 degrees. With repeat measurements made, on average, approximately 6 weeks apart, the 95% velocity magnitude limits of agreement were as follows: Intraobserver -41.3 to +45.2 cm/s; interobserver -29.6 to +46.8 cm/s. There was an 8.6 cm/s interobserver bias in velocity magnitude. We conclude that the dual-beam vector Doppler system can measure blood velocity within its scan plane with low dependence on angle and with similar reproducibility to that of single-beam systems.

Acute hepatitis C virus seroconversion in a Scottish blood donor: HCV antigen is not comparable with HCV nucleic acid amplification technology screening.

BACKGROUND AND OBJECTIVES: This study was conducted to analyse the usefulness of hepatitis C virus (HCV) core antigen tests for the confirmation of HCV infection in a donor presenting as nucleic acid amplification technology (NAT) positive but negative for antibodies to HCV (anti-HCV). MATERIALS AND METHODS: Blood donations were screened, in parallel, for anti-HCV using the Abbott PRISM HCV Chemiluminescent immunoassay (ChLIA) and an 'in-house' HCV NAT (pools of up to 95 donations). An HCV NAT-positive antibody-negative donor was identified. Twelve follow-up samples were obtained and tested with various HCV antigen (including the recently marketed Trak-C second-generation assay) and HCV antibody assays. RESULTS: The single HCV NAT-positive, antibody-negative donation was identified from 1 117 681 donations screened in the 4-year period, July 1999 to June 2003. The index donation was positive by Ortho HCV core antigen enzyme immunoassay (EIA) and Ortho Trak-C (second-generation HCV core antigen EIA). An archive sample, taken 127 days prior to the index donation, was negative for all HCV markers. Subsequent samples demonstrated a loss of reactivity in the Ortho HCV core antigen EIA and reduced activity in the Ortho Trak-C until day 69. Immunoblot (Ortho RIBA-3) and HCV PRISM became positive on day 62, whilst Ortho HCV ELISA was not positive until day 132 or Biorad HCV ELISA until day 160. An alternative immunoblot (Innogenetics Innolia III) was positive from day 55. RNA levels fluctuated considerably during the follow-up period, being completely undetectable by routine screening methods at the time-point around seroconversion; subsequently, antibody was detected using all assays investigated. CONCLUSIONS: This HCV-converting blood donor provided a unique panel of samples for using to assess current (and future) HCV assay systems. The overall test results led to the conclusion that individual HCV antigen testing should not be considered as equivalent to HCV NAT minipool screening. Trak-C antigen testing may be considered as a suitable confirmatory assay for isolated HCV NAT reactivity.