Recognition of advanced level practice against multiprofessional capabilities: Experiences of the first radiography applicants.

INTRODUCTION: Advanced practice is well established in the health professions with multiprofessional capabilities in place in England. To recognise achievement of these capabilities an ePortfolio (supported) route was initiated in 2022. This study aimed to review the demographics and experiences of radiographers applying for recognition in the first year of operation. METHODS: The multi method evaluation consisted of quantitative data analysis of information regarding the first three cohorts of radiographers (n = 40) participating in the NHS England (NHSE) scheme. Interviews with 12 participants was undertaken with thematic analysis of the transcripts. RESULTS: Self-rated scores of expertise were significantly higher by therapeutic radiographers (n = 8) compared to their 32 diagnostic colleagues (t = 5.556; p < 0.01). Radiographers saw the ePortfolio as an opportunity to validate their experience and to evidence parity with other professions. Participants felt the process also enabled critical reflection and gave unseen insight into themselves and their roles. The support of experienced educational supervisors was felt to be vital in this process and for successful completion of portfolio. CONCLUSIONS: Several radiographers have now achieved the necessary standards to achieve NHSE recognition. The evaluation exposed that most radiographers did not have the relevant evidence to hand and the ongoing collection of evidence around capabilities and impact is critical to evidencing advanced practice capabilities. IMPLICATIONS FOR PRACTICE: Radiographers are able to achieve the capabilities expected for multiprofessional practice. Cultural change is required to normalise recording of evidence within practice including case-based discussions, clinical supervision and feedback from colleagues and patients. The support of an experienced educational supervisor aided the critical reflection on practice level.

Reporting radiographer peer review systems: A cross-sectional survey of London NHS Trusts.

INTRODUCTION: Peer review is frequently incorporated within radiographer reporting services. The aim of this study is to establish peer review systems used for radiograph reports provided by reporting radiographers in London. METHODS: An online cross-sectional survey of NHS diagnostic imaging departments was performed. Reporting radiographer demographics (number, frequency of reporting, scope of practice) and systems used to provide peer review of radiograph reports (review frequency, case selection, volume, outcome measure, practitioner performing the review) were collected. RESULTS: Thirteen eligible responses were received (61.9% response rate). Variability was found between Trusts in the number of reporting radiographers, frequency of reporting sessions and scope of practice. Most Trusts (9 of 13, 69.2%) have active peer review systems for radiographer reporting. All peer review systems use random case selection, most often performed on a monthly basis. Both a fixed number or a percentage of cases reported were used, with true positive, true negative, false positive, false negative the most frequent outcome measure. Of the 12 Trusts that have or are planning a peer system, all currently or plan to use reporting radiographers to conduct the review, with five (41.2%) also using consultant radiologists. CONCLUSION: Peer review of radiographer reporting is common in London NHS Trusts although there is variation in the methods used. IMPLICATIONS FOR PRACTICE: Radiographer reports frequently undergo peer review. Standardisation of reporting radiographer peer review systems should be considered, and a standardised systematic peer review system has been proposed.

Clinical reporting of radiographs by radiographers: Policy and practice guidance for regional imaging networks.

OBJECTIVES: Radiographer reporting is an essential component of imaging across the United Kingdom. Since the previous policy and practice guidance in 2004 the role and contribution of reporting radiographers has changed significantly. The move to imaging networks further reinforces the need for consistency in scope of practice and clinical governance for radiographer reporting. KEY FINDINGS: This guidance provides a consistent, evidence-based template for planning a reporting service, resourcing, clinical governance, preceptorship, volume and frequency of reporting, a peer learning framework and expected standards. CONCLUSION: Developed for North Central and East London, this framework and standards will help reduce unwarranted variation. IMPLICATIONS FOR PRACTICE: Consistency in practice could help maximise the contribution of radiographer reporting.

Analysis of Amblyomma surveillance data in the Caribbean: lessons for future control programmes.

Amblyomma variegatum, the Tropical Bont Tick (TBT), is the principal vector of heartwater and is associated with dermatophilosis, major causes of losses in animal production and mortality in Caribbean livestock. From 1995 to 2007, the Caribbean Amblyomma Programme (CAP) supported treatment and surveillance activities in 11 islands of the Eastern Caribbean with an initial objective of eradicating TBT. In addition to control activities, surveillance data were collected between 1997 and 2006 in a unique regional database. We report the analysis of the surveillance data from four islands (Nevis, St Kitts, St Lucia, and Barbados) where control and surveillance followed the initial protocol and where enough data were collected. We describe the evolution of TBT infestation levels and the efforts carried out throughout the surveillance period. Logistic regression identified factors associated with herds found infested with TBT. Overall, treatment programmes were associated with a decrease in proportion of TBT-infested farms. High surveillance efforts were carried out throughout the 1997-2007 period for all island of interest, but inadequate level of surveillance was observed in several quarters especially for St Kitts. Third quarter of the year, as indication of adult TBT seasonality on livestock, was significantly associated with the risk of detecting TBT in Nevis and St Kitts livestock farms. Also, presence of cattle in Nevis farms was shown associated with an increasing probability of farms being declared TBT-infested. Outcomes of these analyses provide basis for recommendations to improve future national and regional control and surveillance activities. This analysis demonstrates the usefulness of long term and adequate surveillance data for control programmes and identification of factors associated with risk of having infested herds.

Advancing Caribbean herbs in the 21st century

The conference was the second in the series on "Advancing Caribbean herbs in the 21st Century". It was organised as the 7th workshop held since 1998 by the Caribbean Association of Researchers and Herbal Practitioners (CARAPA). It was held in conjunction with the 2nd Annual General Meeting and Display of Exhibits of the Caribbean Herbal Business Association (CHBA), with much support from the Inter-American Institute for Cooperation on Agriculture (IICA)

A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention.

BACKGROUND: The unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. Most Western-trained physicians are ignorant of the risks and benefits of this healthcare modality and assessment of acceptance and knowledge would identify appropriate intervention strategies to improve physician-patient communication in this area. METHODS: A cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May-July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests. RESULTS: Of 192 physicians interviewed, most (60.4%) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 +/- 0.29 points or 40% of total possible score) and poor knowledge (mean = 7.77 +/- 0.56 points or 15% of total possible score). Seventy-eight physicians (40.6%) admitted having used herbs in the past, and 60 of these (76.9%) were satisfied with the outcome. Although 52 physicians (27.1%) recommended the use of herbs to their patients only 29 (15.1%) were able to identify at least one known herb-drug interaction. CONCLUSION: The use of herbal remedies is relatively high in Trinidad, as throughout the world, and most patients self-medicate with or without the knowledge of their attending physician. Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. We recommend educational intervention to narrow the gap between acceptance and knowledge so that physicians would be adequately equipped to communicate with their patients on this modality. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention

BACKGROUND: The unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. METHODS: A cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May–July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests. RESULTS: Of 192 physicians interviewed, most (60.4 per cent) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 ñ 0.29 points or 40 per cent of total possible score) and poor knowledge (mean = 7.77 ñ 0.56 points or 15 per cent of total possible score). Seventy-eight physicians (40.6 per cent) admitted having used herbs in the past, and 60 of these (76.9 per cent) were satisfied with the outcome. Although 52 physicians (27.1 per cent) recommended the use of herbs to their patients only 29 (15.1 per cent) were able to identify at least one known herb-drug interaction. CONCLUSION: Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

Herbal remedies today [abstract]

Over the last two decades, phytotherapy, or botanical medicine, and other "non-conventional" therapies have become increasingly prevalent in many countries around the world. Many actions involving WHO and other official agencies have been initiated concerning the regulatory situation, especially for herbal products, to provide reliable information and, further, to break down the barriers between western conventional medicine and complementary/alternative therapies. Alternative models of healthcare have been evolving quite rapidly, and research activity has been directed to the issues of quality, safety and efficacy of the traditional herbal remedies, modern phytomedicinals and the nutraceuticals. In this paper, a critical review has been undertaken of recent scientific and clinical studies which describe a variety of herbal medicinal preparations. An evaluation has been made of reports describing the knowledge, attitudes and practices of healthcare professionals towards herbal medicine. The findings have been translated into suggestions intended to encourage, and to enable, healthcare professionals to raise their awareness, and to improve their knowledge of, the established limitations and benefits of various formulations of herbal medicinal products in current use. (AU)

Screening of medicinal plants from Trinidad and Tobago for antimicrobial and insecticidal properties

Antibacterial activity in 51 extracts from 29 plant species currently used in traditional medicine in Trinidad and the neighbouring Caribbean islands was tested for by the agar dilution streak method using six bacteria: Escherichia coli, Pseudomonas aeruginosa. Salmonella tophimurium, Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus faecalis. The extracts from eight of the plants tested showed significant activity against one or more micro-organisms and the most susceptible bacterium was Staphylococcus aureus. In the bioassays for toxicity towards the Aedes aegypti mosquito the most effective plant extracts were from Justicia pectoralis, Manihot utilissima and Stachytarpheta jamaicensis.(AU)

The occurrence of streptothricosis and its association with Amblyomma variegatum ticks in St. Lucia.

Cattle, horses, sheep and goats in all areas of St. Lucia were examined to ascertain the prevalence and distribution of streptothricosis on the island and to investigate its association with the occurrence of Amblyomma variegatum ticks. Although the disease was found to occur throughout St. Lucia it was more prevalent and generally of a more severe form in areas where A. variegatum ticks are present. A tick control programme in the North of the island appeared to have resulted in a dramatic reduction in the prevalence of the disease.

The occurrence of streptothricosis and its association with Amblyomma variegatum ticks in St. Lucia

Cattle, horses, sheep and goats in all areas of St. Lucia were examined to ascertain the prevalence and distribution of streptothricosis on the island and to investigate its association with the occurrence of Amblyomma variegatum ticks. Although the disease was found to occur throughout St. Lucia it was more prevalent and generally of a more severe form in areas where A. variegatum ticks are present. A tick control programme in the north of the island appeared to have resulted in a dramatic reduction in the prevalence of the disease. (AU)

The Nottingham orthogeriatric unit after 1000 admissions.

Four years experience in the use of a new orthogeriatric unit run jointly by the orthopaedic Trauma service and the Department of Health Care of the Elderly is presented. There were over 1000 admissions during this period. The Unit was opened in 1978 and was established to meet the increasing problems stemming from fractures of the proximal femur in elderly women. During the ten-year period from 1971 to 1981 the number of patients with fractures of the proximal femur admitted to the orthopaedic trauma unit in Nottingham has doubled--from 290 cases in 1971 to 612 cases in 1981. The effect of the orthogeriatric unit has been to reduce the average length of hospital stay for these patients from 66 days in 1977 before the unit opened, to 48 days in 1979 with a rate of discharge to home or to relatives of 69 per cent of patients: inpatient case fatality within the unit has been 5 per cent.

Accuracy of reduction of femoral subcapital fractures.

Fifty-four patients with recent subcapital fractures of the femur underwent a Flynn reduction manoeuvre and are compared with 68 patients who were treated by a different method of reduction. Analysis of the postoperative radiographs showed no significant difference in the accuracy of reduction (0.1 greater than P greater than 0.05). The Flynn reduction manoeuvre is recommended as a method which compares favourably with other manoeuvres.