Clinical audit and research in radiography practice: An exploration of the English landscape.

BACKGROUND: Research and clinical audit are central to the quality improvement (QI) process in healthcare; whereas research produces new knowledge, clinical audit establishes if practice is meeting set standards. Thus, radiographers have responsibility to engaging in these QI activities. This study aimed to explore radiographers' understanding, attitudes and level of involvement in clinical research and audit across England. METHODS: A cross-sectional survey using an online questionnaire for data collection over a 6-week period was employed. The questionnaire consisted of open and closed ended questions. Participants were recruited through social media. The quantitative data obtained was analysed using Statistical Package for Social Sciences (SPSS) Version 26 (IBM Inc, Armonk, NY) whilst content analysis was used to analyse the free-response data. RESULTS: A total of 100 valid responses were obtained after exclusion of 45 partial and/or incomplete responses. Radiographers showed a positive attitude towards involvement in research and audit with overall mean score of 3.85 (SD 0.80) and 4.01 (SD 0.80), respectively. Of the respondents, 35.7% (n = 35/98) were currently involved in clinical audit projects whilst 78.6% (n = 77/98) have previously been involved. Radiographers with postgraduate degrees were significantly more likely to have initiated research, 61.5% (n = 16/26) (p = 0.01) and to have previously been involved with research, 80.8% (n = 21/26) (p = 0.02). A significant association between radiographers' role and implementation of changes, following an audit (p = 0.03) was noted. Similarly, a significant association was noted between radiographers' role and initiation of research (p = 0.05). CONCLUSION: Clinical radiographers in England showed a positive attitude towards research and audit. However, this did not translate into actual participation in research and audit activities. IMPLICATIONS FOR PRACTICE: The need to stimulate clinical radiographers' interest in clinical audit and research is highlighted. Additionally, the findings support the rationale for managers to give more support including protected time to radiographers to engage in QI activities.

The human papillomavirus type 11 E1/\E4 protein is not essential for viral genome amplification.

An abundant human papillomavirus (HPV) protein E1/\E4 is expressed late in the virus life cycle in the terminally differentiated layers of epithelia. The expression of E1/\E4 usually coincides with the onset of viral DNA amplification. However, the function of E1/\E4 in viral life cycle is not completely understood. To examine the role of E1/\E4 in the virus life cycle, we introduced a single nucleotide change in the HPV-11 genome to result in a truncation of E1/\E4 protein without affecting the E2 amino acid sequence. This mutated HPV-11 genome was introduced into a human foreskin keratinocyte cell line immortalized by the catalytic subunit of human telomerase, deficient in p16(INK4a) expression, and previously shown to support the HPV-11 life cycle when grown in organotypic raft culture. We have demonstrated that E1/\E4 is dispensable for HPV-11 viral DNA amplification in the late stages of the viral life cycle.

Holt-Oram syndrome with hypoplastic left heart syndrome in an African child.

This report illustrates the rare association of Holt-Oram syndrome with hypoplastic left heart syndrome hitherto unreported in an African child. The above association is highlighted as this child and the only other case reported in a Caucasian were diagnosed post mortem. The need for early cardiovascular and genetic evaluation or simple detailed family history to aid counselling is also emphasised.

Formation of highly adherent nano-porous alumina on Ti-based substrates: a novel bone implant coating.

Thin, nano-porous, highly adherent layers of anodised aluminium formed on the surface of titanium alloys are being developed as coatings for metallic surgical implants. The layers are formed by anodisation of a 1-5 microm thick layer of aluminium which has been deposited on substrate material by electron beam evaporation. The surface ceramic layer so produced is alumina with 6-8 wt % phosphate ions and contains approximately 5 x 10(8) cm(-2) pores with a approximately 160 nm average diameter, running perpendicular to the surface. Mechanical testing showed the coatings' shear and tensile strength to be at least 20 and 10 MPa, respectively. Initial cell/material studies show promising cellular response to the nano-porous alumina. A normal osteoblastic growth pattern with cell number increasing from day 1 to 21 was shown, with slightly higher proliferative activity on the nano-porous alumina compared to the Thermanox control. Scanning electron microscopy (SEM) examination of the cells on the porous alumina membrane showed normal osteoblast morphology. Flattened cells with filopodia attaching to the pores and good coverage were also observed. In addition, the pore structure produced in these ceramic coatings is expected to be suitable for loading with bioactive material to enhance further their biological properties.

Initiation of glucocorticoid therapy: before or after temporal artery biopsy?

OBJECTIVE: To identify clinical findings in patients with suspected giant cell arteritis (GCA) that may help clinicians decide when to initiate glucocorticoid therapy. PATIENTS AND METHODS: Medical diagnostic codes and surgical indexing were used to identify all patients who had temporal artery biopsy at the Mayo Clinic in Rochester, Minn, between January 1, 1988, and December 31, 1997. Patient medical records were abstracted for pertinent clinical data, glucocorticoid use, and final diagnoses. Sensitivities, specificities, predictive values, and likelihood ratios were calculated for the association of the various clinical findings and the presence of a positive biopsy result. Graphic and arithmetic models were constructed to predict positive temporal artery biopsy results. RESULTS: During the 10-year interval, 1113 patients had temporal artery biopsy. The results were positive for GCA in 373 patients (33.5%) and negative in 740 (665%). Twenty percent of all patients were taking glucocorticoids at the time of biopsy. The presence of jaw claudication had a positive predictive value of 78. Combinations of jaw claudication with new headache, scalp tenderness, and decreased vision had still higher values. Positive likelihood ratios in patients with these combinations and in those with diplopia were greater than 3. A normal erythrocyte sedi-mentation rate in patients not taking corticosteroids provided a high negative likelihood ratio of 40. An arithmetic equation provided the probability of a positive biopsy result on a continuous scale using 6 variables identified by logistic regression. Patients with a greater than 80% chance of a positive biopsy result and those with less than a 10% chance were identified. CONCLUSION: Positive predictive values, likelihood ratios, and an arithmetic formula identify patients who have an increased or decreased chance of a positive temporal artery biopsy result. Use of these methods to determine early initiation of glucocorticoid therapy before temporal artery biopsy or deferral until after biopsy may help reduce both vascular complications of GCA and adverse effects of corticosteroids.

The effects of adding fluoride compounds to a fluoride-free glass ionomer cement on subsequent fluoride and sodium release.

Studies have shown that ions in a glass ionomer matrix are 1-10% of the amounts present in the original glass. To measure more precisely the release from a cement matrix, known amounts of ions were added to LG30 glass which was fluoride and sodium-free. Cement without additions acted as the control. 1.4-1.6% of each of sodium, calcium and aluminum fluorides were added to three portions of control blend. The sodium and fluoride release into deionised water from five discs of each cements blend was measured for 8 months. This represented complete release for sodium but not for fluoride. Traces of fluoride and sodium in the glass produced low but measurable amounts indicating about a third of the fluoride and substantially all sodium present in LG30 was released. The addition of calcium fluoride had no significant effect on sodium or fluoride release and aluminium fluoride minimal effects. Adding sodium fluoride significantly enhanced release of both ions although fluoride release was less than from a glass containing 5% fluoride. Only small proportions of the additions, 2-5% of the fluoride and 13% of sodium, were released. Sodium and fluoride appeared to be released independently. For LG30 cements additives were poor at supplying extra ions.

The cynomolgus monkey eyelid as an anatomic model for oculoplastic surgery.

PURPOSE: To investigate the Cynomolgus monkey eyelid as an experimental model for oculoplastic surgery METHODS: Eyelid and periocular tissue were removed from Cynomolgus monkeys being euthanized. After fixation, the macroscopic and microscopic characteristics of the Cynomolgus monkey eyelid were studied. RESULTS: Macroscopic and microscopic characteristics of the Cynomolgus monkey eyelids were described. The Cynomolgus monkey eyelid bears resemblance to the human eyelid in its compartmentalization and complexity. CONCLUSIONS: The Cynomolgus monkey eyelid is a suitable experimental research model. Its compartmentalization resembles that of the human eyelid both microscopically and macroscopically.

Eyelid lymphatics II: a search for drainage patterns in the monkey and correlations with human lymphatics.

PURPOSE: To study the lymphatic drainage of the cynomolgus monkey through the use of lymphoscintigraphy. METHODS: Lymphoscintigraphy with 500 microCi of 99mTechnetium sulfur colloid injected at specific sites around the eyelids was performed with five cynomolgus monkeys in lateral and ventral positions. RESULTS: Lymphoscintigraphy of the monkey eyelid and periocular tissue revealed lymphatic drainage to the parotid lymph nodes from the entire upper eyelid, medial canthus, and lateral lower eyelid and drainage to the submandibular lymph nodes from the medial and central lower eyelid. In addition to draining to the parotid lymph nodes, the central upper eyelid was also seen to drain to the submandibular lymph nodes. CONCLUSIONS: Lymphoscintigraphy of the cynomolgus monkey eyelids reveals discrete lymphatic drainage pathways for the upper and lower eyelids and a dual pathway for the central upper eyelid. Future studies will help to clarify the lymphatic drainage pathways of human eyelids.

Eyelid lymphatics I: histochemical comparisons between the monkey and human.

PURPOSE: To study the lymphatic drainage of the cynomolgus monkey and human eyelid and periocular tissue by means of histochemistry. METHODS: Eyelid and periocular tissue from three cynomolgus monkeys undergoing sacrifice for glaucoma and retina research purposes and discarded tissue from a wedge resection of one human eyelid were used for histochemical analysis. Lymphatic capillaries were distinguished histochemically in monkey and human eyelids by light microscopy with a 5'-nucleotidase (5'-Nase) staining method. Identification of lymphatic vessels was based on strict morphologic criteria combined with specific 5'-Nase staining. RESULTS: Histochemical analysis with 5'-nucleotidase revealed a subcutaneous and pretarsal lymphatic plexus in both the human and monkey. CONCLUSIONS: Histochemical results demonstrate similar lymphatic plexi in the monkey and human. Future studies will help to clarify the lymphatic drainage pathways of monkey and human eyelids.

Tuberculosis del sistema nervioso central / Central nervous system tuberculousis

La Tuberculosis (TBC) del Sistema Nervioso Central (SNC) y de sus cubiertas es una afección relativamente infrecuente en la población general, aunque en grupos de riesgo, particularmente en pacientes HIV positivos, el número de casos de neurotuberculosis ha aumentado significativamente y los exámenes neurorradiológicos contribuyen en gran medida a su diagnóstico. Se analizaron retrospectivamente las imágenes de Tomografía Computada (TC) y Resonancia Magnética (RM), obtenidas en 8 pacientes con diagnóstico confirmado de : meningitis tuberculosa (n=2); tuberculomas caseosos sólidos (n=3); tuberculoma no caseoso (n=1); absceso tuberculoso (n=1),y cerebritis TBC (n=1). Se discuten brevemente los mecanismos patogénicos de la enfermedad parenquimatosa y su correlación con las imágenes. Los hallazgos en TC y RM en los casos de meningitis son altamente sugestivos de lesión tuberculosa, mientras que en la afectación cerebral algunas características de los granulomas en RM, sin resultar específicas, inducen la inclusión de neurotuberculosis como probabilidad diagnóstica

Tuberculosis del sistema nervioso central / Central nervous system tuberculousis

La Tuberculosis (TBC) del Sistema Nervioso Central (SNC) y de sus cubiertas es una afección relativamente infrecuente en la población general, aunque en grupos de riesgo, particularmente en pacientes HIV positivos, el número de casos de neurotuberculosis ha aumentado significativamente y los exámenes neurorradiológicos contribuyen en gran medida a su diagnóstico. Se analizaron retrospectivamente las imágenes de Tomografía Computada (TC) y Resonancia Magnética (RM), obtenidas en 8 pacientes con diagnóstico confirmado de : meningitis tuberculosa (n=2); tuberculomas caseosos sólidos (n=3); tuberculoma no caseoso (n=1); absceso tuberculoso (n=1),y cerebritis TBC (n=1). Se discuten brevemente los mecanismos patogénicos de la enfermedad parenquimatosa y su correlación con las imágenes. Los hallazgos en TC y RM en los casos de meningitis son altamente sugestivos de lesión tuberculosa, mientras que en la afectación cerebral algunas características de los granulomas en RM, sin resultar específicas, inducen la inclusión de neurotuberculosis como probabilidad diagnóstica (AU)

RM del SNC: uso de una secuencia inversión recuperación sensible al edema / CNS RM imaging: use of an inversion recovery pulse sequence for brain edema

El edema cerebral es el denominador común de un amplio espectro de patologías que frecuentemente afectan al Sistema Nervioso Central (SNC). En la actualidad, su diagnóstico y fundamentalmente su delimitación resultan difíciles con las consecuencias spin-eco (SE de uso habitual en las imágenes por Resonancia Magnética). Con el objeto de superar este inconveniente utilizamos una secuencia Inversión Recuperación (IR), con tiempo de repetición (TR), tiempo de inversión (TI), y tiempo de eco (TE) largos, desarrollada para tal fin. El análisis de la imágenes obtenidas muestra al líquido cefalorraquídeo (LCR) con señal fuertemente hipointensa, el cerebro normal con señal intermedia, las zonas afectadas por tumores u otras patologías con señal hipointensa en relación al cerebro, y el edema como el único elemento hiperintenso permitiendo una clara diferenciación del mismo, con elevada relación contraste-ruido (C/R)

RM del SNC: uso de una secuencia inversión recuperación sensible al edema / CNS RM imaging: use of an inversion recovery pulse sequence for brain edema

El edema cerebral es el denominador común de un amplio espectro de patologías que frecuentemente afectan al Sistema Nervioso Central (SNC). En la actualidad, su diagnóstico y fundamentalmente su delimitación resultan difíciles con las consecuencias spin-eco (SE de uso habitual en las imágenes por Resonancia Magnética). Con el objeto de superar este inconveniente utilizamos una secuencia Inversión Recuperación (IR), con tiempo de repetición (TR), tiempo de inversión (TI), y tiempo de eco (TE) largos, desarrollada para tal fin. El análisis de la imágenes obtenidas muestra al líquido cefalorraquídeo (LCR) con señal fuertemente hipointensa, el cerebro normal con señal intermedia, las zonas afectadas por tumores u otras patologías con señal hipointensa en relación al cerebro, y el edema como el único elemento hiperintenso permitiendo una clara diferenciación del mismo, con elevada relación contraste-ruido (C/R) (AU)

Hepatitis B transmission from contaminated cryopreservation tank.

Over a 25-month period, six multiply transfused patients undergoing cytotoxic treatment for haematological or other malignant disorders developed icteric acute hepatitis B virus (HBV) infection. Bone marrow or peripheral-blood stem cells had been harvested from all six patients and stored in the same cryopreservation tank for possible future transplantation. Human DNA, HBsAg, and HBV DNA with sequences identical to those from four patients with related infections were subsequently found in the liquid nitrogen. Leakage of the cryopreservation bags used to store bone marrow harvested from the first patient when acutely infected with HBV led to contamination of the tank and its contents with HBV and subsequent transmission to patients after transplantation. This incident emphasises the continuing need to screen donors of tissue to be cryopreserved for bloodborne virus infections. It also reinforces the requirement for primary containers used to cryopreserve human tissue to be sealed in a way which prevents exchange of material between the specimen and the liquid nitrogen.

Transrectal ultrasound in the evaluation of rhabdomyosarcoma involving the prostate.

OBJECTIVE: To evaluate transrectal ultrasound as a means of diagnosis and of monitoring patients with rhabdomyosarcoma involving the prostate. PATIENTS AND METHODS: Serial transrectal ultrasonography was utilized to evaluate prostatic rhabdomyosarcoma in three patients. RESULTS: Unlike prostatic adenocarcinoma and transitional cell carcinoma involving the prostate, which are predominantly hypoechoic, the echogenicity of rhabdomyosarcoma is similar to that of the normal prostate. Transrectal ultrasound provided a simple means of monitoring prostate size and sampling tissue in these patients. CONCLUSION: Transrectal ultrasound imaging can be useful in both diagnosis and evaluation of treatment response as well as provide easy access for biopsies in patients with rhabdomyosarcoma involving the prostate.