Reporting radiographers in Norway - A qualitative study on implementation, organisation, and outcomes.

INTRODUCTION: Worldwide, there is an increasing use of imaging services and a shortage of radiologists. One potential solution to this challenge involves introducing task shifting, where radiographers actively contribute to reporting diagnostic images alongside radiologists. This study explored the purpose and value of reporting radiographers in Norway's imaging departments. METHODS: This study used a qualitative design with a descriptive approach. Semi-structured interviews were conducted with eleven participants, comprising managers, radiologists, and reporting radiographers, from four hospital trusts in south Norway. The collected data were analysed using inductive content analysis. RESULTS: The analysis generated three main categories: "Organisation," "Barriers and facilitators," and "Experienced outcome." The study showed that successfully implementing reporting radiographers required careful planning and preparation due to radiologists' resistance. The radiologists and managers experienced that reporting radiographers contributed to increased service quality and better training of radiographers and resident physicians. Reporting radiographers found the combination of reporting and diagnostic radiography tasks rewarding and challenging simultaneously. CONCLUSION: The implementation of reporting radiographers in imaging departments in Norway was described as successful, positively impacting service quality, reporting capacity, and quality development. However, preparation and planning are needed to overcome barriers to task-shifting. IMPLICATIONS FOR PRACTICE: This study shows that with management involvement and careful planning, reporting radiographers contribute to a high-quality imaging service.

Reporting radiographers in Norway - A qualitative interview study.

INTRODUCTION: A number of Norwegian radiographers have attended an advanced programme of education and training in musculoskeletal reporting, some in the UK and some in Norway. The aim of this study was to examine how reporting radiographers, radiologists and managers experienced the education, competence, and role of reporting radiographers in Norway. To our knowledge, the role and function of reporting radiographers in Norway has not yet been explored. METHODS: The study had a qualitative design and was based on eleven individual interviews of reporting radiographers, radiologists, and managers. The participants represented five different imaging departments from four hospital trusts in Norway. The interviews were analyzed using inductive content analysis. RESULTS: The analysis identified two main categories: "Education and training", and "The reporting radiographer". The subcategories were: "Education", "Training", "Competence", and "The new role". The study found the program to be demanding, challenging, and time-consuming. However, the reporting radiographers described it as motivating because they gained new competence. The competence of reporting radiographers was regarded as adequate. The participants found that reporting radiographers had a unique competence in both image acquisition and reporting, and they were described as a missing link between radiographers and radiologists. CONCLUSION: Reporting radiographers are experienced as an asset for the department. Reporting radiographers not only contribute to musculoskeletal imaging reports but are also important for collaboration, training, and professional development in imaging, and in collaborating with orthopedics. This was seen to increase the quality of musculoskeletal imaging. IMPLICATIONS FOR PRACTICE: Reporting radiographers are a valuable resource in image departments, especially in smaller hospitals where the shortage of radiologists is noticeable.

Immune responses in patients with metastatic renal cell carcinoma treated with dendritic cells pulsed with tumor lysate.

Patients with metastatic renal cell carcinoma (mRCC) have a limited life expectancy but still a subset of these patients develop immune and clinical responses after immunotherapy including dendritic cell (DC) vaccination. In a recently published phase I/II trials, fourteen HLA-A2 negative patients with progressive mRCC were vaccinated with autologous DC pulsed with allogeneic tumour lysate. Low-dose IL-2 administered subcutaneously was given concomitantly. In this study, we analysed lysate specific proliferation of PBMCs from these patients together with the TH1/TH2 balance of the responding T cells. Also, serum concentrations of IL-10, IL-12, IL-15, IL-17 and IL-18 from these patients and additional thirteen HLA-A2 positive mRCC patients treated with autologous DC pulsed with survivin and telomerase peptides were analysed during vaccination to identify systemic immune responses and potential response biomarkers. In HLA-A2 negative mRCC patients a spontaneous predominance of TH1 secreting tumour lysate specific T cells was observed prior to vaccination in patients attaining stable disease (SD) during treatment whereas patients with continued progressive disease (PD) had a mixed TH1/TH2 response. The TH1/TH2 balance was unchanged during vaccination also when tumour lysate specific T cell responses increased. An increase in IL-12, IL-17 and IL-18 serum concentrations was observed during vaccination but no difference between patients with SD and PD was observed. IL-10 or IL-15 was not measurable in serum.

Plasma levels of interleukin-6 and C-reactive protein are associated with physical inactivity independent of obesity.

It is recognized that the path from physical inactivity and obesity to lifestyle-related diseases involves low-grade inflammation, indicated by elevated plasma levels of inflammatory markers. Interestingly, contracting skeletal muscle is a major source of circulating interleukin-6 (IL-6) in response to acute exercise, but with a markedly lower response in trained subjects. As C-reactive protein (CRP) is induced by IL-6, we hypothesized that basal levels of IL-6 and CRP reflect the degree of regular physical activity when compared with other markers of inflammation associated with lifestyle-related morbidity. Fasting plasma/serum levels of IL-6, IL-18, CRP, tumur necrosis factor-alpha (TNF-alpha), soluble TNF receptor II (sTNF-RII), and adiponectin were measured in healthy non-diabetic men and women (n=84). The amount of leisure-time physical activity (LTPA) was assessed by interview. Obesity was associated with elevated insulin, C-peptide, triglycerides, low-density lipoprotein, IL-6, CRP, and adiponectin (all P<0.05). Importantly, physical inactivity was associated with elevated C-peptide (P=0.036), IL-6 (P=0.014), and CRP (P=0.007) independent of obesity, age, gender, and smoking. Furthermore, the LTPA score was inversely associated with IL-6 (P=0.017) and CRP (P=0.005), but with neither of the other markers. The results indicate that low levels of IL-6 and CRP - not IL-18, TNF-alpha, sTNF-RII, or adiponectin - reflect regular physical activity.

[Intraspinal infections in patients treated with epidural analgesia]. / Intraspinale infeksjoner hos pasienter behandlet med epiduralanalgesi.

BACKGROUND: Intraspinal infections (meningitis, epidural abscess) may occur spontaneously or present as a complication of epidural analgesia. MATERIAL AND METHODS: All cases during the 1991-99 period of clinically significant intraspinal infections in patients treated with epidural analgesia were analysed from clinical records in our institution. RESULTS: One patient with uncertain, three patients with well documented meningitis, and one patient with epidural abscess were identified. The treatment time varied from 12 to 49 days in patients with documented infections; the number of catheters varied from one to six. Skin bacteria were isolated from one patient (Staphylococcus sp), opportunistic bacteria (Pseudomonas, Enterococcus, Micrococcus sp) were isolated from three others. Two of the patients were at risk because of probable immunosuppression and chronic infections. Diagnosis and surgery of the patient who developed epidural abscess were significantly delayed because of three negative MRs with and without gadolinium enhancement. INTERPRETATION: Because of the danger of infection related to epidural analgesia, all patients have to be properly monitored as long as they have epidural catheters and also after the removal of catheters. Some epidural abscesses spread longitudinally and may present as a diffuse process on MR without mechanical compression of the medulla, and may be interpreted as negative findings. Myelography with CT scan is an alternative method of investigation in such cases. Early neurosurgical diagnosis and intervention may prevent serious complications.