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1.
Osteoporos Int ; 35(8): 1451-1460, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38795142

RESUMO

This study uses NHS waiting times and osteoporosis medication community prescription datasets to assess the impact of COVID-19 on DXA waits and osteoporosis medication patterns in England. Results show significant increases in DXA waiting list times and variation in prescription rates. Investment is needed to improve waiting list times. PURPOSE: This study investigates the impact of COVID-19 on DXA scan waiting lists, service recovery and osteoporosis medication prescriptions in the NHS following the March 2020 national lockdowns and staff redeployment. METHODS: Data from March 2019 to June 2023, including NHS digital diagnostics waiting times (DM01) and osteoporosis medication prescriptions from the English Prescribing Dataset (EPD), were analysed. This encompassed total waiting list data across England's seven regions and prescribing patterns for various osteoporosis medications. Analyses included total activity figures and regression analysis to estimate expected activity without COVID-19, using R for all data analysis. RESULTS: In England, DXA waiting lists have grown significantly, with the yearly mean waiting list length increasing from 31,851 in 2019 to 65,757 in 2023. The percentage of patients waiting over 6 weeks for DXA scans rose from 0.9% in 2019 to 40% in 2020, and those waiting over 13 weeks increased from 0.1% in 2019 to 16.7% in 2020. Prescription trends varied, with increases in denosumab, ibandronic acid and risedronate sodium and decreases in alendronic acid, raloxifene hydrochloride and teriparatide. A notable overall prescription decrease occurred in the second quarter of 2020. CONCLUSION: COVID-19 has significantly increased DXA scan waiting lists with ongoing recovery challenges. There is a noticeable disparity in DXA service access across England. Osteoporosis care, indicated by medication prescriptions, also declined during the pandemic. Addressing these issues requires focused investment and effort to improve DXA scan waiting times and overall access to osteoporosis care in England.


Assuntos
Absorciometria de Fóton , Conservadores da Densidade Óssea , COVID-19 , Prescrições de Medicamentos , Osteoporose , Medicina Estatal , Listas de Espera , Humanos , Inglaterra/epidemiologia , COVID-19/epidemiologia , Absorciometria de Fóton/estatística & dados numéricos , Absorciometria de Fóton/métodos , Conservadores da Densidade Óssea/uso terapêutico , Osteoporose/tratamento farmacológico , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/tendências , Padrões de Prática Médica/estatística & dados numéricos , SARS-CoV-2 , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos
2.
Osteoporos Int ; 27(8): 2567-76, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26919995

RESUMO

UNLABELLED: Significant increased hip fracture incidence has been reported in the year following total knee replacement. This study demonstrates that bone and muscle loss is a post-surgical consequence of total knee replacement, alongside poor outcomes in function and activity potentially contributing to reduced quality of life and increased hip fracture risk. INTRODUCTION: A significant increase in hip fracture incidence in the year following total knee replacement (TKR) surgery has been reported. This study investigated function and activity following TKR and the effects of limited mobility on bone and muscle loss and their potential contribution to hip fracture risk. METHODS: Changes in dual-energy X-ray absorptiometry (DXA) (GE Lunar Prodigy, Bedford MA), bone mineral density (BMD) at the neck of femur (NOF), total hip region (TH) and lumbar spine were measured alongside leg lean tissue mass (LLTM) in post-menopausal Caucasian females following TKR (N = 19) compared to controls (N = 43). Lumbar spine trabecular bone scores (TBSs) were calculated. Ipsilateral/contralateral weight bearing, lower limb function, 3-day pedometer readings, pain levels and falls were also recorded. Measurements were obtained at pre-surgery baseline and at 6 weeks, 6 months and 12 months post-surgery. RESULTS: No statistically significant differences were demonstrated between groups at baseline bilaterally in LLTM or BMD at the NOF and TH. Losses in ipsilateral NOF and TH BMD and contralateral LLTM were significantly higher in the TKR group at 6 months. Impairment in function and weight bearing persisted in the TKR group 12 months post-operatively alongside deficits in bilateral muscle mass and ipsilateral NOF and TH BMD. Falls incidence was not significantly higher in the TKR group. CONCLUSIONS: Bone loss at the hip with associated muscle loss is a consequence of TKR that, in addition to poor patient outcomes in function and activity, potentially contributes to increased hip fracture risk in the year following surgery.


Assuntos
Artroplastia do Joelho , Densidade Óssea , Fraturas do Quadril/epidemiologia , Absorciometria de Fóton , Idoso , Feminino , Fêmur/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Pós-Menopausa , Qualidade de Vida , Fatores de Risco , População Branca
3.
Transpl Infect Dis ; 16(2): 213-24, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24589027

RESUMO

BACKGROUND: Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations. METHODS: Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006. RESULTS: A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died. CONCLUSIONS: This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation.


Assuntos
Blastomicose/epidemiologia , Coccidioidomicose/epidemiologia , Doenças Endêmicas , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Histoplasmose/epidemiologia , Transplante de Órgãos/efeitos adversos , Adolescente , Adulto , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Blastomicose/tratamento farmacológico , Criança , Coccidioidomicose/tratamento farmacológico , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Comorbidade , Feminino , Histoplasmose/tratamento farmacológico , Humanos , Incidência , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
4.
Radiography (Lond) ; 30(4): 1125-1135, 2024 07.
Artigo em Inglês | MEDLINE | ID: mdl-38797045

RESUMO

INTRODUCTION: The conventional anti-scatter grid is widely used in X-ray radiography to reduce scattered X-rays, but it increases patient dose. Scatter-correction software offers a dose-reducing alternative by correcting for scattered X-rays without a physical grid. Grids and software correction are necessary to reduce scatter radiation and improve image quality especially for the large body parts. The scatter correction can be beneficial in situations where the use of grid is challenging. The implementation of grids and advanced software correction techniques is imperative to ensure that radiographic images maintain high levels of clarity, contrast, and resolution, and ultimately facilitating more accurate diagnoses. This study compares image quality and radiation dose for abdomen exams using scatter correction software and physical grids. METHODS: An anthropomorphic phantom (abdomen) underwent imaging with varying fat and lean tissue layers and body mass index (BMI) configurations. Imaging parameters included 70 kVp tube voltage, 110 cm SID, and Automatic Exposure Control (AEC) both lateral and central chambers. AP abdomen X-ray projections were acquired with and without an anti-scatter grid, and scatter correction software was applied. Image quality was assessed using contrast to noise ratio (CNR) and signal to noise ratio (SNR) metrics. The tube current mAs was considered an exposure factor that affected radiation dose and was used to compare the VG software and physical grid. Radiation dose was measured using Dose Area Products (DAP). The effective dose was estimated using Monte Carlo simulation-PCXMC software. Paired t-tests were used to investigate the image quality difference between the Gridless and VG software, Gridless and PG, and VG software and PG approaches. For the DAP and effective dose, paired t-test was used to investigate the difference between VG software and PG. RESULTS: Images acquired with a grid had the highest mean CNR (71.3 ± 32) compared to Gridless (50 ± 33.8) and scatter correction software (59.3 ± 37.9). The mean SNR of the grid images was (82.7.3 ± 38.9), which is 18% higher than the scatter correction software images (70.4 ± 36.7) and 29% higher than in the Gridless images (62.9.3 ± 34). The mean DAP value was reduced by 81% when the scatter correction software was used compared to the grid (mean: 65.4 µGy.m2 and 338.2 µGy.m2, respectively) with a significant difference (p = 0.001). Scatter correction software resulted in a lower effective dose compared to physical grid use, (mean difference± SD = -0.3 ± 0.18 mSv) with a significant difference (P = 0.02). CONCLUSION: Scatter correction software reduced the radiation dose required but images employing a grid yielded higher CNR and SNR. However, the radiation dose reduction might affect the image quality to a level that impacts the diagnostic information available. Thus, further research needs to be conducted to optimise the use of the scatter correction software. IMPLICATION FOR PRACTICE: Objectively, X-ray scatter correction software might be promising in conditions where a grid cannot be applied.


Assuntos
Imagens de Fantasmas , Doses de Radiação , Radiografia Abdominal , Espalhamento de Radiação , Software , Humanos , Radiografia Abdominal/métodos , Raios X
5.
Radiography (Lond) ; 28(4): 1010-1015, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35926446

RESUMO

INTRODUCTION: The COVID-19 pandemic created major challenges across society, healthcare provision and also for those delivering healthcare education programmes. Clinical placements were disrupted and, in many incidences cancelled. Higher education institutions were required to move completely to online delivery methods with little notice. This created significant additional workload, stress and the need to learn new skills at a time of great uncertainty. This study explored the risks of burnout in academic radiographers during the first 12 months of the pandemic. METHODS: A survey was circulated using SurveyMonkey™ via personal, national and international networks, including the European Federation of Radiographer Societies (EFRS), to reach as many academic radiographers as possible. Disengagement and exhaustion were measured using the Oldenburg burnout inventory. Descriptive statistics and a one-way ANOVA were used to analyse the quantitative data using STATA V16 (Statacorp, TA). RESULTS: 533 academic radiographers responded to the survey from 43 different countries. Mean disengagement was in the medium range and exhaustion was high for the total dataset. In a subset of countries with 10 or more responses, there was significant variation between countries, with the UK having highest mean exhaustion score and the UK, Ireland and France sharing the highest mean disengagement score. In the total dataset, 86% agreed workload had increased during the pandemic and 35% had considered leaving academia in the last year. CONCLUSION: These data demonstrate the stark reality of the impact of the COVID-19 pandemic on academic radiographers' workload, wellbeing, and intention to leave their roles. IMPLICATIONS FOR PRACTICE: COVID-19 has had a significant impact on academic radiographers and this study highlights the urgent need for remedial measures to better support academic radiographers in order to ensure a sufficient, and sustainable workforce.


Assuntos
Esgotamento Profissional , COVID-19 , Pessoal Técnico de Saúde , Esgotamento Profissional/epidemiologia , COVID-19/epidemiologia , Humanos , Pandemias , Inquéritos e Questionários
6.
Radiography (Lond) ; 28 Suppl 1: S35-S40, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35927184

RESUMO

INTRODUCTION: The COVID-19 pandemic arrived in Europe in March 2020 and created major challenges across healthcare provision and for healthcare education programmes as well as having a major impact on society. Within the profession of Radiography changes in medical imaging, radiotherapy, and teaching practices have been reported along with the negative impact on radiographers and students. The aim of this study was to investigate key challenges relating to academic practice during the COIVD-19 pandemic; how radiography academics have coped and to identify recommendations for further support required to facilitate recovery of the academic faculty as the pandemic ebbs. METHODS: A survey was circulated using SurveyMonkey™ via personal, national and international networks, including the European Federation of Radiographer Societies (EFRS), to reach as many academic radiographers as possible. Open questions relating to the challenges of providing radiography education during the COVID-19 pandemic and the and coping strategies used were included. Thematic analysis was conducted using NVivo (QSR International, MA). RESULTS: 533 academic radiographers responded to the whole survey from 43 different countries, with 340 responses relating to challenges and 327 for coping strategies. The main themes for the challenges were clinical practice, communication with colleagues, lack of face to face, managing change, students (support), and staff support. The coping strategy themes were communication with colleagues, physical exercise, self-care and wellbeing. CONCLUSION: These data demonstrate a multitude of challenges for academic radiographers and the pressure they worked under during the first year of the COVID-19 pandemic was clear. However, the majority employed healthy coping strategies to help them deal with the pressure, uncertainty and trauma of the situation. IMPLICATIONS FOR PRACTICE: COVID-19 had a significant impact on academic radiographers and while many reported good strategies for coping, the level of pressure is unsustainable. This study highlights the need to support academic radiographers to ensure a sustainable workforce.


Assuntos
COVID-19 , Adaptação Psicológica , Pessoal Técnico de Saúde , COVID-19/epidemiologia , Humanos , Pandemias , Radiografia
7.
Radiography (Lond) ; 28 Suppl 1: S93-S99, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36109264

RESUMO

OBJECTIVES: The COVID-19 pandemic caused an unprecedented health crisis resulting in over 6 million deaths worldwide, a figure, which continues to grow. In addition to the excess mortality, there are individuals who recovered from the acute stages, but suffered long-term changes in their health post COVID-19, commonly referred to as long COVID. It is estimated there are currently 1.8 million long COVID sufferers by May 2022 in the UK alone. The aim of this narrative literature review is to explore the signs, symptoms and diagnosis of long COVID and the potential impact on imaging services. KEY FINDINGS: Long COVID is estimated to occur in 9.5% of those with two doses of vaccination and 14.6% if those with a single dose or no vaccination. Long COVID is defined by ongoing symptoms lasting for 12 or more weeks post acute infection. Symptoms are associated with reductions in the quality of daily life and may involve multisystem manifestations or present as a single symptom. CONCLUSION: The full impact of long COVID on imaging services is yet to be realised, but there is likely to be significant increased demand for imaging, particularly in CT for the assessment of lung disease. Educators will need to include aspects related to long COVID pathophysiology and imaging presentations in curricula, underpinned by the rapidly evolving evidence base. IMPLICATIONS FOR PRACTICE: Symptoms relating to long COVID are likely to become a common reason for imaging, with a particular burden on Computed Tomography services. Planning, education and updating protocols in line with a rapidly emerging evidence base is going to be essential.


Assuntos
COVID-19 , COVID-19/complicações , COVID-19/diagnóstico por imagem , Humanos , Pandemias , SARS-CoV-2 , Síndrome de COVID-19 Pós-Aguda
8.
Radiography (Lond) ; 27 Suppl 1: S58-S62, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34380589

RESUMO

OBJECTIVES: This paper will outline the status and basic principles of artificial intelligence (AI) in radiography along with some thoughts and suggestions on what the future might hold. While the authors are not always able to separate the current status from future developments in this field, given the speed of innovation in AI, every effort has been made to give a view to the present with projections to the future. KEY FINDINGS: AI is increasingly being integrated within radiography and radiographers will increasingly be working with AI based tools in the future. As new AI tools are developed it is essential that robust validation is undertaken in unseen data, supported by more prospective interdisciplinary research. A framework of stronger, more comprehensive approvals are recommended and the involvement of service users, including practitioners, patients and their carers in the design and implementation of AI tools is essential. Clearer accountability and medicolegal frameworks are required in cases of erroneous results from the use of AI-powered software and hardware. Clearer career pathways and role extension provision for healthcare practitioners, including radiographers, are required along with education in this field where AI will be central. CONCLUSION: With the current growth rate of AI tools it is expected that many of the applications in medical imaging will continue to develop to more accurate, less expensive and more readily available versions moving from the bench to the bedside. The hope is that, alongside efficiency and increased patient throughput, patient centred care and precision medicine will find their way in, so we will not only deliver a faster, safer, seamless clinical service but also one that will have the patients at its heart. IMPACT FOR PRACTICE: AI is already reaching clinical practice in many forms and its presence will continue to increase over the short and long-term future. Radiographers must learn to work with AI, embracing it and maximising the positive outcomes from this new technology.


Assuntos
Inteligência Artificial , Software , Previsões , Humanos , Estudos Prospectivos , Radiografia
9.
Radiography (Lond) ; 26(3): 198-204, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32052762

RESUMO

INTRODUCTION: Diagnostic student radiographer attrition is reported at 14%, 6% higher than the average for higher education, however, little research has been undertaken on this subject. This study explored risk factors for attrition and strategies that enabled these to be overcome. METHODS: A two-phase study was undertaken. Phase one: data for 579 former student diagnostic radiographers (468 completers and 111 non-completers) from 3 English universities were analysed. Logistic regression was used to estimate odds ratios and 95% confidence intervals for completion based on individual characteristics. Phase two: content analysis of data from an online survey of 186 current UK student diagnostic radiographers exploring their experiences was undertaken. RESULTS: Phase one: Attrition was 19%. Increased age, non A-level entry qualifications and poor academic performance were predictors of attrition (p < 0.005). Phase two: Challenges reported by groups identified as 'at risk' showed that for mature students and those with non-traditional entry qualifications, external responsibilities/pressures and financial pressures were likely to be the greatest cause of attrition and for younger students with traditional qualifications, academic difficulty and excessive workload were most significant. Scientific learning and academic writing were identified as the most common academic difficulties by all groups. Poor mental health may also be a risk factor. CONCLUSION: Although characteristics were identified that increased the chance of attrition, the study concluded that attrition is most likely to be multi-factorial. Academic and personal support were identified as key in students continuing their studies when they considered leaving. Clinical placement experience is likely to influence continuation decisions. IMPLICATIONS FOR PRACTICE: Transparency around course expectations and academic requirements together with ensuring high quality clinical placements may assist in reducing attrition.


Assuntos
Escolha da Profissão , Radiografia , Evasão Escolar/estatística & dados numéricos , Estudantes de Ciências da Saúde/estatística & dados numéricos , Tecnologia Radiológica/educação , Adolescente , Adulto , Feminino , Humanos , Masculino , Risco , Reino Unido , Adulto Jovem
10.
Radiography (Lond) ; 25(4): 359-364, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31582245

RESUMO

INTRODUCTION: We evaluated the reporting competency of radiographers providing preliminary clinical evaluations (PCE) for intraluminal pathology of computed tomography colonography (CTC). METHOD: Following validation of a suitable tool, audit was undertaken to compare radiographer PCE against radiology reports. A database was designed to capture radiographer and radiologist report data. The radiographer's PCE of intraluminal pathology was given a score, the "pathology discrepancy and significance" (PDS) score based on the pathology present, any discrepancy between the PCE and the final report, and the significance of that discrepancy on the management of the patient. Agreement was assessed using percentage agreement and Kappa coefficient. Significant discrepancies between findings were compared against endoscopy and pathology reports. RESULTS: There was agreement or insignificant discrepancy between the radiographer PCE and the radiology report for 1736 patients, representing 97.0% of cases. There was a significant discrepancy between findings in 2.8% of cases and a major discrepancy recorded for 0.2% of cases. There was a 98.4% agreement in the 229 cases where significant pathologies were present. CONCLUSION: From a database of 1815 studies acquired over three years and representing work done in a clinical environment, this study indicates a potential for trained radiographers to provide a PCE of intraluminal pathology.


Assuntos
Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada , Neoplasias Colorretais/diagnóstico por imagem , Competência Clínica , Colo/patologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/patologia , Humanos , Radiografia/normas , Radiografia/estatística & dados numéricos , Estudos Retrospectivos
11.
Radiography (Lond) ; 24(2): 151-158, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29605113

RESUMO

INTRODUCTION: Disuse osteopenia is a known consequence of reduced weight-bearing and has been demonstrated at the hip following leg injury but has not been specifically studied in postmenopausal women. METHOD: Bilateral DXA (GE Lunar Prodigy) bone mineral density (BMD) measurements were taken at the neck of femur (NOF), total hip region (TH) and lumbar spine in postmenopausal female groups comprising controls (N = 43), new leg fractures (#<3wks) (N = 9), and participants who had sustained a leg fracture more than one year previously (#>1yr) (N = 24). #>1yr were assessed at a single visit and the remaining groups at intervals over twelve months. Weight-bearing, function, 3-day pedometer readings, and pain levels were also recorded. RESULTS: The #<3wks demonstrated significant (p < 0.05) losses in ipsilateral TH BMD at 6 weeks from baseline 0.927 ± 0.137 g/cm2, to 0.916 ± 0.151 g/cm2 improving to 0.946 ± 0.135 g/cm2 (n.s) at 12 months following gradual return to normal function and weight-bearing activity. The #>1yr scored significantly below controls in almost all key physical and functional outcomes demonstrating a long-term deficit in hip bone density on the ipsilateral side. CONCLUSION: The clinical significance of post-fracture reduction in hip BMD is a potential increased risk of hip fracture for a variable period that may be mitigated after return to normal function and weight-bearing. Improvement at 12 months in #<3wks is not consistent with #>1yr results indicating that long-term impairment in function and bone health may persist for some leg fracture patients. Unilateral bone loss could have implications for Fracture Liaison Services when assessing the requirement for medication post fracture.


Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas/etiologia , Colo do Fêmur/diagnóstico por imagem , Fraturas do Quadril/etiologia , Fraturas por Osteoporose/complicações , Fraturas da Tíbia/complicações , Absorciometria de Fóton , Idoso , Estudos Transversais , Feminino , Quadril/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Pós-Menopausa , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Suporte de Carga
12.
Radiography (Lond) ; 24 Suppl 1: S28-S32, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30166005

RESUMO

INTRODUCTION: The Francis Report recommended an increased focus on compassion in healthcare, and recognition and non-judgmental acceptance of diversity is fundamental in compassionate patient care. The aim of this study was to achieve a wider understanding of diversity that includes individual patient needs, expectations, perceptions and feelings during diagnostic imaging. METHODS: Using thirty-four semi-structured interviews with individual patients, this qualitative study explored their experiences of undergoing diagnostic radiography examinations and asked what compassionate care meant to them and how it is perceived and manifested in the brief, task-focussed and highly technical diagnostic projection imaging encounter. Data were analysed using Thematic Analysis. RESULTS: Four key themes were identified from the analysis; these were: feelings and vulnerability; hidden emotions; professionalism and valued qualities and communication. CONCLUSION: Diversity is defined not only in terms of socio-cultural differences but also psychological ones, i.e. individual emotional and attitudinal characteristics, some of which may be consciously or unconsciously concealed. In order that patients are treated equitably and all of their care needs met, recommendations include a broader focus in education and training to include adapting communication skills and techniques in perception and expression of non-verbal cues. Further research into the pressures specific to the time-pressured, task-focussed, highly technical and rapid turnover environment of projection imaging radiography and how this impacts upon compassionate patient care would make a useful contribution to the field.


Assuntos
Competência Cultural/psicologia , Diversidade Cultural , Diagnóstico por Imagem , Empatia , Relações Profissional-Paciente , Populações Vulneráveis/psicologia , Comunicação , Emoções , Feminino , Humanos , Entrevistas como Assunto , Masculino
13.
Radiography (Lond) ; 23 Suppl 1: S48-S52, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28780951

RESUMO

INTRODUCTION: Academia is one area of practice in which radiographers can specialise; they compile approximately 2% of the total radiography profession in the UK, but are highly influential and essential for the education and development of the workforce in addition to undertaking research. However, the academic environment is very different to clinical practice and a period of transition is required. METHODS: Data were collated to explore the age and retirement profile of the academic radiography workforce in the UK; to understand the research time allocated to this workforce; the time required to develop a clinical radiographer into an academic and the mentorship and succession planning provisions nationally. An online UK wide survey was conducted and sent to all 24 Universities delivering radiography education within the UK. RESULTS: Eighteen out of 24 Universities in the UK responded to the survey. Approximately 30% of radiography academics are due to retire over the next 10 years, with over 25% of radiographers who currently hold a doctorate qualification included within this figure. Those entering academia have notably lower qualifications as a group than those who are due to retire. Developing clinical radiographers into academics was thought to take 1-3 years on average, or longer if they are required to undertake research. CONCLUSION: There is vulnerability in the academic radiography workforce. Higher education institutions need to invest in developing the academic workforce to maintain research and educational expertise, which is underpinned by master's and doctorate level qualifications.


Assuntos
Tecnologia Radiológica , Universidades , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aposentadoria/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido , Recursos Humanos
14.
Leukemia ; 31(1): 151-158, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27363283

RESUMO

Genomic studies have identified recurrent somatic mutations in acute leukemias. However, current murine models do not sufficiently encompass the genomic complexity of human leukemias. To develop preclinical models, we transplanted 160 samples from patients with acute leukemia (acute myeloid leukemia, mixed lineage leukemia, B-cell acute lymphoblastic leukemia, T-cell ALL) into immunodeficient mice. Of these, 119 engrafted with expected immunophenotype. Targeted sequencing of 374 genes and 265 frequently rearranged RNAs detected recurrent and novel genetic lesions in 48 paired primary tumor (PT) and patient-derived xenotransplant (PDX) samples. Overall, the frequencies of 274 somatic variant alleles correlated between PT and PDX samples, although the data were highly variable for variant alleles present at 0-10%. Seventeen percent of variant alleles were detected in either PT or PDX samples only. Based on variant allele frequency changes, 24 PT-PDX pairs were classified as concordant while the other 24 pairs showed various degree of clonal discordance. There was no correlation of clonal concordance with clinical parameters of diseases. Significantly more bone marrow samples than peripheral blood samples engrafted discordantly. These data demonstrate the utility of developing PDX banks for modeling human leukemia, and emphasize the importance of genomic profiling of PDX and patient samples to ensure concordance before performing mechanistic or therapeutic studies.


Assuntos
Xenoenxertos/patologia , Leucemia/genética , Doença Aguda , Adolescente , Adulto , Animais , Células Sanguíneas/transplante , Transplante de Medula Óssea , Bovinos , Criança , Perfilação da Expressão Gênica , Humanos , Imunofenotipagem , Leucemia/patologia , Camundongos , Pessoa de Meia-Idade , Adulto Jovem
15.
Radiography (Lond) ; 27 Suppl 1: S1-S2, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34518061
16.
Biomed Res Int ; 2016: 3574258, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28025642

RESUMO

We aimed to study whether short-duration vibration exercise or football sessions of two different durations acutely changed plasma markers of bone turnover and muscle strain. Inactive premenopausal women (n = 56) were randomized to complete a single bout of short (FG15) or long duration (FG60) small sided football or low magnitude whole body vibration training (VIB). Procollagen type 1 amino-terminal propeptide (P1NP) was increased during exercise for FG15 (51.6 ± 23.0 to 56.5 ± 22.5 µg·L-1, mean ± SD, P < 0.05) and FG60 (42.6 ± 11.8 to 50.2 ± 12.8 µg·L-1, P < 0.05) but not for VIB (38.8 ± 15.1 to 36.6 ± 14.7 µg·L-1, P > 0.05). An increase in osteocalcin was observed 48 h after exercise (P < 0.05), which did not differ between exercise groups. C-terminal telopeptide of type 1 collagen was not affected by exercise. Blood lactate concentration increased during exercise for FG15 (0.6 ± 0.2 to 3.4 ± 1.2 mM) and FG60 (0.6 ± 0.2 to 3.3 ± 2.0 mM), but not for VIB (0.6 ± 0.2 to 0.8 ± 0.4 mM) (P < 0.05). Plasma creatine kinase increased by 55 ± 63% and 137 ± 119% 48 h after FG15 and FG60 (P < 0.05), but not after VIB (26 ± 54%, NS). In contrast to the minor elevation in osteocalcin in response to a single session of vibration exercise, both short and longer durations of small sided football acutely increased plasma P1NP, osteocalcin, and creatine kinase. This may contribute to favorable effects of chronic training on musculoskeletal health.


Assuntos
Creatina Quinase/sangue , Exercício Físico , Osteocalcina/sangue , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Futebol , Vibração , Adulto , Feminino , Humanos , Ácido Láctico/sangue , Pessoa de Meia-Idade , Fatores de Tempo
17.
J Leukoc Biol ; 67(5): 735-41, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10811015

RESUMO

In macrophages, bacterial lipopolysaccharide (LPS) has been noted to mimic certain effects of the sphingolipid ceramide, suggesting that ceramide may be involved in macrophage activation by LPS and/or that LPS utilizes ceramide-related signaling pathways. Putative downstream targets of ceramide include a ceramide-activated (serine/threonine) protein kinase (CAPK) and phosphatase (CAPP). However, the potential role of tyrosine phosphorylation pathways in macrophage response to ceramide has not been examined. Herein we report that cell-permeable analogs of ceramide up-regulate both inducible nitric oxide synthase (iNOS) and tumor necrosis factor (TNF) production in RAW 264.7 murine macrophages. Herbimycin A and genistein, potent natural inhibitors of protein tyrosine (but not serine/threonine) phosphorylation, block ceramide-induced iNOS and TNF production. Furthermore, the highly src-family selective pyrazolopyrimidine inhibitor PP1 also blocks ceramide-induced iNOS and TNF production in RAW 264.7 cells. We found that PP1 also inhibits ceramide-mediated tyrosine phosphorylation of the src-family kinase hck. These data indicate that src-related tyrosine kinases play a critical role in macrophage activation by ceramide.


Assuntos
Ceramidas/farmacologia , Macrófagos/fisiologia , Óxido Nítrico Sintase/biossíntese , Proteínas Tirosina Quinases/metabolismo , Esfingosina/análogos & derivados , Fator de Necrose Tumoral alfa/biossíntese , Animais , Benzoquinonas , Linhagem Celular , Indução Enzimática , Inibidores Enzimáticos/farmacologia , Genisteína/farmacologia , Interferon gama/farmacologia , Lactamas Macrocíclicas , Ativação de Macrófagos/fisiologia , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Camundongos , Óxido Nítrico Sintase Tipo II , Fosforilação , Quinonas/farmacologia , Proteínas Recombinantes , Rifabutina/análogos & derivados , Esfingosina/farmacologia
18.
Pediatr Infect Dis J ; 20(9): 837-43, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11734760

RESUMO

BACKGROUND: The relationship of antibiotic susceptibility to clinical outcome in children with pneumococcal meningitis is uncertain. Previous studies have been limited by inclusion of relatively few patients infected with nonsusceptible pneumococci and inconsistent use of empiric vancomycin. METHODS: Medical records of 86 children with culture-confirmed pneumococcal meningitis at a single institution from October, 1991, to October, 1999, were retrospectively reviewed, and differences in presentation and outcome based on antibiotic susceptibility of pneumococcal isolates were assessed. RESULTS: Of 86 isolates 34 were nonsusceptible to penicillin (12 resistant). Of 60 isolates for which cefotaxime susceptibility data were available, 17 were nonsusceptible (12 resistant). Antibiotic susceptibility was not significantly associated with death, intensive care unit admission, mechanical ventilation, focal neurologic deficits, seizures, secondary fever, abnormal neuroimaging studies or hospital days. Children with penicillin-resistant isolates had significantly higher median blood leukocyte counts (24,100/microliter vs. 15,700/microliter, P = 0.03) and lower median CSF protein concentrations (85 mg/dl vs. 219 mg/dl, P = 0.04), were more likely to have a CSF glucose concentration of > or = 50 mg/dl (7 of 11 vs. 15 of 68, P = 0.009) and had lower rates of sensorineural hearing loss (1 of 8 vs. 25 of 40, P = 0.02) than children with isolates that were not resistant to penicillin. Children with cefotaxime-nonsusceptible isolates had an increased median duration of primary fever compared with those with nonsusceptible strains (6 days vs. 3.5 days, P = 0.02). CONCLUSIONS: In children with pneumococcal meningitis, penicillin resistance was associated with a reduced risk of hearing loss, while cefotaxime resistance was associated with a longer duration of fever. Other outcome measures were not significantly influenced by the antibiotic susceptibility of pneumococcal isolates.


Assuntos
Corticosteroides/uso terapêutico , Antibacterianos , Quimioterapia Combinada/uso terapêutico , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/tratamento farmacológico , Resistência às Penicilinas , Líquido Cefalorraquidiano/efeitos dos fármacos , Líquido Cefalorraquidiano/microbiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prontuários Médicos , Meningite Pneumocócica/mortalidade , Testes de Sensibilidade Microbiana , Probabilidade , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Taxa de Sobrevida , Resultado do Tratamento
19.
J Ark Med Soc ; 94(6): 263-6, 1997 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9392928

RESUMO

Streptococcus pneumoniae is the most common cause of pediatric invasive infections and an important cause of morbidity and mortality. In the past, S. pneumoniae responded universally to penicillin until nonsusceptible isolates were first noted in the 1960s. Before 1990, penicillin-nonsusceptible isolates remained a minor component of all reported isolates. Since that time, 20-30% of isolates in many centers in the United States and up to 50% of isolates in some other countries are penicillin-nonsusceptible. Of greater concern has been the development of isolates which are nonsusceptible to more than one antimicrobial agent. This review presents data on pediatric invasive pneumococcal disease in Arkansas and outlines the new treatment recommendations which have been developed in response to these problems. Streptococcus pneumoniae is an important pathogen worldwide and is considered the most common etiology of bacterial sinusitis, otitis media, pneumonia, meningitis and bacteremia. Before 1990, 95-96% of pneumococcal isolates were susceptible to penicillin. The first report of penicillin-nonsusceptible S. pneumoniae was made by Hansman and Bullen in 1967, who identified the strain in the sputum of a patient with hypogammaglobulinemia. Soon thereafter, penicillin-nonsusceptible pneumococci were reported in New Guinea and Australia as well. Over the last several years, the incidence of penicillin-nonsusceptible isolates has greatly increased. Of particular concern is the concomitant increase in the number of organisms that are nonsusceptible to more than one antimicrobial agent. Due to the development of such isolates, clinicians are having to approach patients with invasive disease due to pneumococci more cautiously. In an attempt to clarify confusion with terminology, the Centers for Disease Control and Prevention (CDC) have recommended the same nomenclature be used to classify resistance for all organisms: nonsusceptible organisms are those with an MIC (minimal inhibitory concentration) greater than or equal to that defined for the intermediate category of resistance and the term resistant should be reserved for those organisms with an MIC greater than or equal to that defined for the resistant category. Therefore, resistant isolates are a subgroup of the nonsusceptible isolates.


Assuntos
Antibacterianos/administração & dosagem , Resistência a Múltiplos Medicamentos , Resistência às Penicilinas , Infecções Pneumocócicas/tratamento farmacológico , Antibacterianos/efeitos adversos , Criança , Relação Dose-Resposta a Droga , Esquema de Medicação , Humanos , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos
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