Determining diagnostic radiographer staffing requirements: A workload-based approach.

INTRODUCTION: The topic of healthcare human resource planning for diagnostic radiographers has received limited research attention to date. This research is concerned with developing a framework that can be used to determine diagnostic radiographer staffing requirements at a unit- or department level (i.e. at the micro-level). METHODS: An inductive approach is applied to formulate requirement specifications that inform the development of the framework. A number of verification and validation activities are performed, including theoretical verification and a case study application. RESULTS: The diagnostic radiographer staffing framework consists of seven steps that comprise a workload-based approach to determining the number of full time equivalent diagnostic radiographers that are required for each modality, or group of modalities. Both clinical and non-clinical activities are considered, and guidance is provided on calculating staffing requirements to cover leave allowances. A number of potential approaches to determining activity times are also discussed. CONCLUSION: The framework represents a holistic approach to determining the required number of diagnostic radiographers at a practice-level, that is designed to remain relevant as technological advances are made in the field of diagnostic radiography. IMPLICATIONS FOR PRACTICE: By providing a practical guideline, with accompanying examples, the framework is expected to hold value for individuals involved in the management of diagnostic radiography practices. The framework proposes an approach to a topic that affects every radiography practice in operation yet has received limited attention in literature to date.

Hepatic adenomatosis: MR imaging features.

Hepatocellular adenomas are rare benign liver neoplasms that commonly occur in women with a history of oral contraceptives intake for more than 2 years. Hepatic adenomatosis is characterized by the presence of multiple adenomas, arbitrarily > than 10, involving both lobes of the liver, without any history of steroid therapy or glycogen storage disease. Although the adenomas in liver adenomatosis are histologically similar to other adenomas, liver adenomatosis appears to be a separate clinical entity. Adenomas in hepatic adenomatosis may be of the inflammatory, hepatocyte nuclear factor 1alpha-mutated, or beta-catenin-mutated subtype, and accordingly show variable imaging appearances. Hepatic adenomatosis carries the risk of impaired liver function, hemorrhage and malignant degeneration. We report a case with the inflammatory subtype of hepatic adenomatosis in a 39-year-old woman with liver steatosis. The magnetic resonance imaging features using extracellular gadolinium chelates and hepatocyte-targeted contrast agents are described.

Obstetric brachial plexus injury complicated with glenohumeral dysplasia.

Brachial plexus injury is the most common cause of plegic arm in neonates. Detection of nerve root avulsions and intraspinal nerve lesions is most valuable for treatment strategy. Magnetic resonance imaging (MRI) is the modality of choice for imaging the brachial plexus in infants as it allows visualization and localization of different types of nerve lesions in a noninvasive way and without radiation exposure. Conventional radiography of the shoulder is of interest in follow-up to assess osseous deformities of the glenoid fossa and humeral head. We report a case of obstetric brachial plexus injury complicated with glenohumeral shoulder deformity in a 3-year-old girl.

Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial.

BACKGROUND: A pilot study (NCT00316563) to determine if delta-9-tetrahydrocannabinol (THC) can improve taste and smell (chemosensory) perception as well as appetite, caloric intake, and quality of life (QOL) for cancer patients with chemosensory alterations. PATIENTS AND METHODS: Adult advanced cancer patients, with poor appetite and chemosensory alterations, were recruited from two sites and randomized in a double-blinded manner to receive either THC (2.5 mg, Marinol(®); Solvay Pharma Inc., n = 24) or placebo oral capsules (n = 22) twice daily for 18 days. Twenty-one patients completed the trial. At baseline and posttreatment, patients completed a panel of patient-reported outcomes: Taste and Smell Survey, 3-day food record, appetite and macronutrient preference assessments, QOL questionnaire, and an interview. RESULTS: THC and placebo groups were comparable at baseline. Compared with placebo, THC-treated patients reported improved (P = 0.026) and enhanced (P < 0.001) chemosensory perception and food 'tasted better' (P = 0.04). Premeal appetite (P = 0.05) and proportion of calories consumed as protein increased compared with placebo (P = 0.008). THC-treated patients reported increased quality of sleep (P = 0.025) and relaxation (P = 0.045). QOL scores and total caloric intake were improved in both THC and placebo groups. CONCLUSIONS: THC may be useful in the palliation of chemosensory alterations and to improve food enjoyment for cancer patients.

Sepsis and septic shock: pathophysiological and cardiovascular background as basis for therapy.

INTRODUCTION: Sepsis and septic shock are common causes for admission to intensive care units. The morbidity and mortality remain unacceptably high despite the advanced treatments. OBJECTIVES: To review the most commonly reported underlying mechanisms of sepsis and septic shock, besides discussion of sepsis-induced cardiovascular dysfunction. Therapeutic strategies for sepsis-induced myocardial depression are briefly discussed. DATA SYNTHESIS: The development of sepsis and septic shock is multifactorial. Two major mechanisms contribute to the haemodynamic collapse. The extrinsic and intrinsic mechanisms induce a complex cascade which results in the release of pro- and anti-inflammatory mediators. Sepsis develops when the initial, appropriate host response to an infection becomes amplified and then dysregulated leading to haemodynamic and circulatory changes. The pro-inflammatory mediators tumour necrosis factor alpha, interleukin-beta and nitric oxide play a significant role in sepsis-related hypotension, shock and depression of cardiomyocyte contractility. Septic cardiac dysfunction can be explained by various mechanisms: changes in circulating volume, down-regulation of beta-adrenergic receptors, depressed post-receptor signalling pathways, reduced calcium release from the sarcoplasmic reticulum and impaired electromechanical coupling and reduced calcium sensibility at the myofibrillar level. Mitochondrial derangement seems to be of great importance in tissue injury and sepsis-associated multi organ failure. There is no consistent protocol for treating sepsis and septic shock. Guidelines include early goal-directed therapy, source control and haemodynamic supportive measures. CONCLUSION: Further studies are needed to distinguish the importance of these various mechanisms. We recommend that further investigational work should focus on the recovery of the mitochondria-related bio-energetic shut down as the mitochondria could play a key role in the understanding of apoptosis and protective measures. Understanding the pathophysiology of sepsis and septic shock will inevitably lead to a more accurate treatment of these still too often fatal syndromes.