Australian radiographer roles in the emergency department; evidence of regulatory compliance to improve patient safety - A narrative review.

OBJECTIVES: Using a narrative approach, this paper aims to determine the extent of Australian radiographers' regulatory compliance to improve patient safety when performing appendicular X-ray and non-contrast brain computed tomography (CT) in the Emergency Department (ED). KEY FINDINGS: A narrative review explored relevant literature and key regulatory policy. Ten documents were identified, three main themes were developed related to the radiographer roles in X-ray request justification, dose optimisation and preliminary image evaluation (PIE). Radiographers were equally aware of justification and optimisation pre and post the introduction of a Medical Code of Practice. The collective PIE accuracy of radiographers remained unaffected by changes in mode of PIE delivery and regulatory factors but varied based on the anatomical region. CONCLUSION: While current Australian regulations mandate radiographer request justification, dose optimisation and PIE, the degree of compliance by Australian radiographers remains uncertain. Current literature provides evidence that radiographers can improve patient care and safety through justification, optimisation, and PIE delivery. Change in workplace practice, supported by key stakeholders including radiologists, is essential to integrate radiographers' functions into routine ED clinical practice. Further research is required to audit radiographers' regulatory compliance to improve patient safety. IMPLICATIONS FOR PRACTICE: Patient safety in ED can be improved with timely and accurate diagnosis provided by radiographers. Radiographers have a professional obligation to adhere to the capabilities and standards for safe medical radiation practice defined by Australian regulations. Therefore, radiographers must justify the X-ray request, optimise the radiation dose where appropriate and communicate urgent or unexpected findings to the referrer.

Successful outcome following resection of metachronous pancreatic metastasis from a rhabdomyosarcoma.

BACKGROUND: Pancreatic metastases (PM) are rare, comprising 3% of pancreatic tumours removed in sizable series of operations. This report presents the first case of metachronous pancreatic metastases from rhabdomyosarcoma successfully treated by pancreaticoduodenectomy. CASE REPORT: A 19-year old man was admitted with a tumor in the head of the pancreas, 1 year after undergoing removal of an alveolar RMS from the right hand. . Computed tomography (CT) scan demonstrates a solitary hypodence tumour of the pancreas. The patient underwent a pancreaticoduodenectomy and the postoperative course was uneventful. Pathologic examination confirmed the metastatic alveolar RMS without lymph node involvement. At most recent follow-up, 36 months after pancreaticoduodenectomy, the patient has no evidence of disease. CONCLUSION: Although rare, rhabdomyosarcoma can metastasize to the pancreas. The surgeons must be aware of this complication, and that such pancreatic metastases are potentially resectable with a good long term outcome.

From Langmuir-Blodgett to Grafted Films.

A locally organized monolayer film strongly attached to a gold surface is obtained by transfer of a Langmuir-Blodgett (LB) film of octadecylamine (ODA) or alcohol (ODOH) onto a Au surface and simultaneous oxidative electrografting of this film still in contact with the aqueous subphase. As opposed to LB films, these films resist ultrasonication; and unlike electrografted films, they are organized monolayers by construction. They are characterized by AFM (atomic force microscopy), water contact angle, ellipsometry, XPS (X-ray photoelectron spectroscopy), IRRAS (infrared reflection absorption spectroscopy), and GIXD (grazing incidence X-ray diffraction).

Covalent modification of iron surfaces by electrochemical reduction of aryldiazonium salts.

Electrochemical reduction of aryldiazonium salts (in acetonitrile or acidic aqueous medium) on an iron or mild steel surface permits the strong bonding (which resists an ultrasonic cleaning) of aryl groups on these surfaces. Attachment of aryl groups was demonstrated by the combined used of electrochemistry, infrared spectroscopy and polarization modulation infrared reflection spectroscopy (PMIRRAS), Rutherford backscattering, X-ray photoelectron spectroscopy, and capacity measurements. The substituents of aryl groups, which can be widely varied, include NO2, I, COOH, and long alkyl chains. It is shown that the attachment of the aryl groups is to an iron and not to an oxygen atom and that the bond is covalent.

Electrochemical oxidation of sigma-complex-type intermediates in aromatic nucleophilic substitutions.

A series of sigma-adducts (1H-...7H-) derived from the addition of 2-nitropropenide ion to various nitrobenzofuroxans and nitrobenzofurazans have been oxidized electrochemically. The results show that the rearomatization of the carbocyclic ring of these adducts as well as that of a few additional 4,6-dinitrobenzofuroxan adducts (8 H- a-c) is associated with much higher oxidation potentials than found for the same process in the dinitro- and trinitrobenzene series. Especially high Eo values are measured for the oxidation of the 2-nitropropenide 4,6-dinitro- and 4-nitro-6-trifluoromethylsulfonylbenzofuroxan adducts 1H- and 4H- in acetonitrile: E (1H-)= 1.15 V versus SCE; Eo(4H-)=1.33V versus SCE. These values fit well with the available evidence that the chemical oxidation of these adducts requires the use of very strong oxidizing agents to proceed efficiently. The mechanism for the oxidation process has been established. It is shown to involve transfer of two electrons and liberation of one proton per sigma-complex precursor with no evidence whatsoever for the intermediacy of radical anionic species.

Health-related messages in consumer magazine advertising.

OBJECTIVE: To characterize the patterns of health-related messages in consumer advertising from U.S. magazines. DESIGN: Observational survey of advertisements occupying a third of a page or more from the January 1994 issues of the 11 most popular consumer magazines. MEASUREMENTS AND MAIN RESULTS: Health messages were present in 22.8% (85/372) of all the advertisements reviewed. Of the advertisement categories (prescription medication, over-the-counter medication, exercise-related product, health service, health device, diet/health-related food, and other), over-the-counter medications were the most common among the advertisements that had health messages (32.9%, 28/85) (7.5% of the total advertisements, 28/372). The five advertisements for prescription medications were duplications of two different advertisements, one for a hair promotion product and one for hormone replacement therapy. Products related to diet and exercise together represented 29.4% (25/85) of all advertisements with health messages. Three advertisements (3.5%) were for health devices, and five (5.9%) were for health services. CONCLUSIONS: Health-related messages are frequent in consumer advertising. The effects of health marketing on consumer protection, health care costs, and the physician-patient relationship are discussed.

Two-dimensional imaging of soot volume fraction by the use of laser-induced incandescence.

A recently developed laser-induced incandescence technique is used to make novel planar measurements of soot volume fraction within turbulent diffusion flames and droplet flames. The two-dimensional imaging technique is developed and assessed by systematic experiments in a coannular laminar diffusion flame, in which the soot characteristics have been well established. With a single point calibration procedure, agreement to within 10% was found between the values of soot volume fraction measured by this technique and those determined by conventional laser scattering-extinction methods in the flame. As a demonstration of the wide range of applicability of the technique, soot volume fraction images are also obtained from both turbulent ethene diffusion flames and from a freely falling droplet flame that burns the mixture of 75% benzene and 25% methanol. For the turbulent diffusion flames, approximately an 80% reduction in soot volume fraction was found when the Reynolds number of the fuel jet increased from 4000 to 8000. In the droplet flame case, the distribution of soot field was found to be similar to that observed in coannular laminar diffusion flames.

The triglyceride connection in atherosclerosis.

OBJECTIVE: To examine the proposed mechanism of triglyceride-induced atherogenesis, to address the controversy surrounding serum triglycerides as a coronary heart disease (CHD) risk factor, and to recommend an appropriate therapeutic approach to hypertriglyceridemia. DATA SOURCES: Studies, review articles, and editorials published since 1976. A MEDLINE search of English-language literature was conducted using the terms triglyceride and hypertriglyceridemia. STUDY SELECTION: Studies, review articles, and editorials were selected for detailed review if they addressed the pathogenesis of triglyceride-induced atherosclerosis, the controversy associated with elevated serum triglyceride as a CHD risk factor, and hypertriglyceridemia treatment options. DATA EXTRACTION: Data were reviewed that described the atherogenicity of chylomicron and very low-density lipoprotein (VLDL) remnants, the inverse relationship that exists between high-density lipoprotein (HDL) and serum triglyceride, the hypertriglyceridemia treatment controversy, and the treatment options of diet, exercise, weight control, alcohol restriction, and medication. DATA SYNTHESIS: Hypertriglyceridemia is a well-known risk factor for pancreatitis. However, its role in atherogenesis is less well defined. Several proposed connections appear to exist between hypertriglyceridemia and atherosclerosis, including the inverse correlation between triglycerides and HDL, the presumed atherogenicity of triglyceride-rich lipoprotein remnant particles, the potential resultant increase in the serum concentration and atherogenicity of low-density lipoprotein (LDL), and the proposed interaction between serum triglyceride and the fibrinolytic/coagulation system. Clinical trials addressing this issue offer mixed results that are subject to interpretation. Diet, exercise, weight control, alcohol restriction, and certain lipid-lowering medications are effective at reducing serum triglyceride. CONCLUSIONS: Hypertriglyceridemia is a theoretical risk factor for CHD because of the increased production of atherogenic chylomicron and VLDL remnants, the inverse relationship present between serum triglyceride and HDL, the possible resultant increase in LDL attributable to remnant-reduced hepatic LDL-receptors as well as the formation of more dense and, therefore, more atherogenic LDL, and to the interaction between serum triglyceride and the fibrinolytic/coagulation system. However, most clinical trials that have found hypertriglyceridemia to be a risk factor for CHD do not include other CHD risk factors in their analyses. Therapeutic intervention to lower serum triglyceride with diet, exercise, and/or drugs is definitely recommended in the treatment and/or prevention of pancreatitis; however, the role of triglyceride-lowering to reduce CHD risk remains controversial.

Preventing complications in the CAVH patient.

Continuous arteriovenous hemofiltration (CAVH) is a recently developed extracorporeal technique for treating the fluid overloaded, critically ill patient. Severe complications can occur during this procedure, including clotting and malfunction of the filter, exsanguination, or fluid and electrolyte imbalance. The critical care nurse who understands the principles of filtration, the concepts of heparinization, and the care and maintenance of the large invasive lines required for CAVH can frequently prevent these complications.

New considerations for Haemophilus influenzae type b vaccination.

The immunogenicity, efficacy, adverse effects, dosage recommendations, and cost of the three commercially available Haemophilus influenzae type b (Hib) conjugate vaccines are discussed. Three Hib conjugate vaccines are licensed for use in children 15 months of age or older: ProHIBiT (Connaught), HibTITER (Praxis), and PedvaxHIB (Merck). HibTITER and PedvaxHIB were recently approved for use in infants as young as two months of age; both have demonstrated efficacy in preventing Hib disease in this age group, whereas ProHIBIT has not been shown to afford adequate protection in young infants. Because the three vaccines induce markedly different immunologic responses, they cannot be considered interchangeable and the recommended dosage schedules differ. The Centers for Disease Control Immunization Practices Advisory Committee (ACIP) and the American Academy of Pediatrics (AAP) both recommend that all infants be immunized with a complete series of either HibTITER or PedvaxHIB beginning routinely at two months or as soon as possible thereafter. The cost of a single dose is similar for the three Hib conjugate vaccines; full immunization with HibTITER is more expensive than with ProHIBiT or PedvaxHIB because four doses are required for completion of the series. Selection of the appropriate Hib vaccine for infants should be based on availability, cost, and the clinician's interpretation of existing data.

Population pharmacokinetics of intravenous indomethacin in neonates with symptomatic patent ductus arteriosus.

The population pharmacokinetics of intravenous indomethacin were investigated with 665 indomethacin serum concentrations from 83 neonates (mean +/- SD: gestational age, 28.8 +/- 2.5 weeks; postnatal age, 5.7 +/- 4.7 days; birth weight, 1.13 +/- 0.40 kg) receiving indomethacin for symptomatic patent ductus arteriosus. A one-compartment open model was used for pharmacokinetic analysis. Hypotheses were tested to determine which developmental and demographic data influenced clearance (CL) and volume of distribution (V(area)). In the final regression equation CL and V(area) were modeled as a function of body weight and postnatal age (PNA) from 0 to 20 days. Final estimates were as follows: CL (ml/hr) = 2.63.weight (kg) + 0.244.PNA (days) and V(area) (L) = 0.28.weight (kg) + 0.0041.PNA (days). The coefficients of variation for interindividual variability in CL and V(area) were 77% and 28%, respectively. Intraindividual variability was 19%. These mean population parameter estimates should prove useful in designing dosage regimens to achieve desired indomethacin concentrations for neonates from 0 to 20 days of age with symptomatic patent ductus arteriosus.