• Radiographer reporting in the UK: A longitudinal analysis

      Snaith, Beverly; Hardy, Maryann L.; Lewis, Emily F. (2015-05)
      Radiographer reporting of plain film radiographs is an established role in the UK. Despite this previous research has demonstrated widespread inconsistencies in implementation, scope and utilisation. A cross-sectional postal survey was undertaken to provide a longitudinal insight into changes in radiographer reporting practice. The sample comprised all individual hospital sites in the UK, Channel Islands and Isle of Man with both a radiology and trauma service A response rate of 63.7% (n = 325/510) was achieved. Reporting radiographers were in place at 179 sites (55.1%) but less likely to be employed at sites with a minor injury unit rather than a full emergency department (χ2 = 71.983; p < 0.001; d.f. = 1). Radiographer utilisation has increased since 2007, although local barriers to implementation and activity were identified. Geographical variation was evident in relation to reporter employment and anatomical scope. A significant association was noted between broader anatomical scope and a wider range of referral sources (χ2 = 34.441; p < 0.001; d.f. = 1). Delayed reporting of radiographs remains the standard service delivery model across the UK. This study confirms the significant contribution that radiographers are making to reporting capacity in the UK, although there continue to be geographical variations, particularly around anatomical scope and referral groups.
    • Radiographer reporting in the UK: Is the current scope of practice limiting plain film reporting capacity?

      Milner, R.C.; Culpan, Gary; Snaith, Beverly (2016)
      Objective: To update knowledge on individual radiographer contribution to plain-film reporting workloads; to assess whether there is scope to further increase radiographer reporting capacity within this area. Methods: Reporting radiographers were invited to complete an online survey. Invitations were posted to every acute National Health Service trust in the UK whilst snowball sampling was employed via a network of colleagues, ex-colleagues and acquaintances. Information was sought regarding the demographics, geographical location and anatomical and referral scope of practice. Results: A total of 259 responses were received. 15.1% and 7.7% of respondents are qualified to report chest and abdomen radiographs, respectively. The mean time spent reporting per week is 14.5 h (range 1–37.5). 23.6% of radiographers report only referrals from emergency departments whilst 50.6% of radiographers have limitations on their practice. Conclusion: The scope of practice of reporting radiographers has increased since previous studies; however, radiographer reporting of chest and abdomen radiographs has failed to progress in line with demand. There remain opportunities to increase radiographer capacity to assist the management of reporting backlogs. Advances in knowledge: This study is the first to examine demographic factors of reporting radiographers across the UK and is one of the largest in-depth studies of UK reporting radiographers, at individual level, to date.
    • Radiographer reporting: A literature review to support cancer workforce planning in England

      Culpan, Gary; Culpan, A.-M.; Docherty, P.; Denton, E. (2019)
      Objective: Clinical Imaging contributes to screening, diagnosis, planning and monitoring of treatment and surveillance in cancer care. This literature review summarises evidence about radiographer reporting to help imaging service providers respond to Health Education England's 2017 Cancer Workforce Plan project to expand radiographer reporting in clinical service provision. Key findings: Papers published between 1992 and 2018 were reviewed (n ¼ 148). Evidence related to dynamic examinations (fluoroscopy, ultrasound) and mammography was excluded. Content was analysed and summarised using the following headings: clinical scope of practice, responsibilities, training, assessment, impact in practice and barriers to expansion. Radiographer reporting is well established in the United Kingdom. Scope of practice varies individually and geographically. Deployment of appropriately trained reporting radiographers is helping the NHS maintain high quality clinical imaging service provision and deliver a cost-effective increase in diagnostic capacity. Conclusion: Working within multiprofessional clinical imaging teams, within a defined scope of practice and with access to medical input when required, reporting radiographers augment capacity in diagnostic pathways and release radiologist time for other complex clinical imaging responsibilities.
    • Radiographers as doctors: A profile of UK doctoral achievement

      Snaith, Beverly; Harris, Martine A.; Harris, R. (2016-11)
      Radiography aspires to be a research active profession, but there is limited information regarding the number of individuals with, or studying for, a doctoral award. This study aims to profile UK doctoral radiographers; including their chosen award, approach and employment status. This was a prospective cohort study utilising an electronic survey. No formal database of doctoral radiographers existed therefore a snowball sampling method was adopted. The study sample was radiographers (diagnostic and therapeutic) based in the UK who were registered with the Health and Care Professions Council (HCPC) and who held, or were studying for, a doctoral award. A total of 90 unique responses were received within the timescale. The respondents comprised 58 females (64.4%) and the majority were diagnostic radiographers (n = 71/90; 78.9%). The traditional PhD was the most common award, although increasing numbers were pursuing Education or Professional Doctorates. An overall increase in doctoral studies is observed over time, but was greatest amongst those working in academic institutions, with 63.3% of respondents (n = 57/90) working solely within a university, and a further 10% employed in a clinical–academic role (n = 9/90). This study has demonstrated that radiography is emerging as a research active profession, with increasing numbers of radiographers engaged in study at a doctoral level. This should provide a platform for the future development of academic and clinical research.
    • Radiology responsibilities post NPSA guidelines for nasogastric tube insertion: A single centre review

      Snaith, Beverly; Flintham, K. (2015-02)
      There are well-recognised complications associated with malposition of nasogastric (NG) tubes. In 2011 the UK National Patient Safety Agency (NPSA) published an alert regarding their insertion and position confirmation. This alert also identified the expected radiology standards for both image acquisition and reporting. This was a retrospective review of referrals over a six-month period within a multi-site NHS Trust. A consecutive sampling approach was used and radiology reports where the text included the terms “NG tube”, “nasogastric” or “feeding” were included. Data were collected from the radiology information system and NG tube visibility and image quality were confirmed by two independent reviewers. 1137 examinations demonstrated an NG tube, of which 68.3% were performed to check tube position. There was statistically significant correlation between lower radiation exposure and non-visualisation (Fishers exact test, p < 0.001). The number of examinations with higher exposure index (EI) in the NG check cohort suggests that the radiographer increased the exposure to improve visualization (x2 = 2.846; 95% CI; p = 0.046), although the utility of this is unproven. Malplaced tubes were demonstrated either in the respiratory tract (1.8%) or proximal gastrointestinal tract (8.6%) as a result of insufficient length introduced. The prompt acquisition and reporting of radiographs is essential to reduce the risk of NG tube complications. Respiratory tract misplacement rates were in line with the published literature, but this study does raise concern regarding the number of tubes located in the proximal GI tract. Radiology's responsibility in accurate and effective reporting of medical interventions is significant.
    • A randomized controlled trial of a specialist liaison worker model for young people with intellectual disabilities with challenging behaviour and mental health needs.

      Raghavan, R.; Newell, Robert J.; Waseem, F.; Small, Neil A. (01/05/2009)
      Background Twenty six young people with intellectual disabilities and mental health needs from Pakistani and Bangladeshi communities were recruited as part of a bigger study to examine the effectiveness of a liaison worker in helping young people and their families access appropriate intellectual disabilities and mental health services. Method Twelve young people were randomly allocated to the treatment group, which had the help of the liaison worker, and 14 young people were allocated to the control group without the help of a liaison worker. Baseline measures were undertaken with all the young people and their carers. This was followed by a 9-month trial, consisting of the liaison worker helping the treatment group to get in touch with and take up appropriate services, mainly in the areas of psychiatric appointments, benefits advice, house adaptations, leisure facilities and support and care for the young person. The control group participants did not have the access to the liaison worker and were accessing services using the normal routine. Assessments were carried out posttreatment to assess whether the use of a liaison worker had had any effect on outcomes for the two groups. Results Twelve young people completed the study in the treatment group and 14 in the control group. Participants allocated to the specialist liaison worker had statistically significantly more frequent contact with services and with more outcomes, than the control group, and significantly lower scores on the Strengths and Difficulties Questionnaire (SDQ). Conclusion The use of specialist liaison services in ensuring adequate access to services for young people with learning disabilities and mental health needs from the South Asian community proved to be significant and effective compared with young people and their families accessing services on their own.
    • Re-Walking the City: People with Dementia Remember.

      Capstick, Andrea; Chatwin, John (2012)
      In recent years walking interviews have emerged as a valuable alternative to the standard research interview, particularly in studies related to place, community, and the urban environment (Clark and Emmel 2010). Although there is little literature on the use of walking interviews with people who have dementia, the method is particularly appropriate for this participant group, due to the strong memories for place and past events that are usually retained by people with dementia, even when short term memory deteriorates (Chaudhury 2008). Narrative biography work with people who have dementia shows a repeated tendency to use geographical markers as ¿signposts¿ to particular memories (Bryce et al 2010). In 2010 the authors piloted the use of walking interviews with three people with dementia within a care home environment. The film record of the process suggests that the combination of physical movement and reminiscence which was involved both facilitated and enhanced communication for people with dementia. These findings led to the present work which is based on walking interviews with people who have dementia in places which have particular meaning for them, such as the street where they grew up; the school they attended; a former workplace; public park; sports ground or other familiar space. The oral presentation will include film clips, contrasting ¿static¿ communication with each participant, with his or her verbal production, or non-verbal communication, in response to environmental prompts and recovered sights and sounds. In addition, we will draw on the film data to explore a series of thought-provoking questions related to changing inner and outer landscapes, the vagaries of memory, and the psychogeography of dementia. Can the frequently pathologised ¿wandering¿ of people with dementia in time and space be rehabilitated using situationist concepts such as the dérive and the flaneur?
    • Re-Walking the City: People with Dementia Remember.

      Capstick, Andrea (2015)
      Within the dominant biomedical discourse, late-life dementia is regarded as a pathological condition characterised by short-term memory loss, word finding difficulties and ‘problem behaviours’ such as ‘wandering and ‘repetitive questioning’. As its title suggests, one of the main purposes of this chapter is to shift the focus from what people with late-life dementia forget to what they remember, particularly as this relates to places they have known much earlier in life. A central part of my argument is that dementia, often somewhat crudely represented as wholesale memory loss, might better be regarded as a form of spatio-temporal disruption; a disruption which intersects with the theoretical territory of psychogeography.
    • A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

      Randell, Rebecca; Honey, S.; Hindmarsh, J.; Alvarado, Natasha; Greenhalgh, J.; Pearman, A.; Long, A.; Cope, A.; Gill, A.; Gardner, Peter H.; et al. (2017-06)
      Background: The implementation of robot-assisted surgery (RAS) can be challenging, with reports of surgical robots being underused. This raises questions about differences compared with open and laparoscopic surgery and how best to integrate RAS into practice. Objectives: To (1) contribute to reporting of the ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer) trial, by investigating how variations in the implementation of RAS and the context impact outcomes; (2) produce guidance on factors likely to facilitate successful implementation; (3) produce guidance on how to ensure effective teamwork; and (4) provide data to inform the development of tools for RAS. Design: Realist process evaluation alongside ROLARR. Phase 1 – a literature review identified theories concerning how RAS becomes embedded into practice and impacts on teamwork and decision-making. These were refined through interviews across nine NHS trusts with theatre teams. Phase 2 – a multisite case study was conducted across four trusts to test the theories. Data were collected using observation, video recording, interviews and questionnaires. Phase 3 – interviews were conducted in other surgical disciplines to assess the generalisability of the findings. Findings: The introduction of RAS is surgeon led but dependent on support at multiple levels. There is significant variation in the training provided to theatre teams. Contextual factors supporting the integration of RAS include the provision of whole-team training, the presence of handpicked dedicated teams and the availability of suitably sized operating theatres. RAS introduces challenges for teamwork that can impact operation duration, but, over time, teams develop strategies to overcome these challenges. Working with an experienced assistant supports teamwork, but experience of the procedure is insufficient for competence in RAS and experienced scrub practitioners are important in supporting inexperienced assistants. RAS can result in reduced distraction and increased concentration for the surgeon when he or she is supported by an experienced assistant or scrub practitioner. Conclusions: Our research suggests a need to pay greater attention to the training and skill mix of the team. To support effective teamwork, our research suggests that it is beneficial for surgeons to (1) encourage the team to communicate actions and concerns; (2) alert the attention of the assistant before issuing a request; and (3) acknowledge the scrub practitioner’s role in supporting inexperienced assistants. It is beneficial for the team to provide oral responses to the surgeon’s requests. Limitations: This study started after the trial, limiting impact on analysis of the trial. The small number of operations observed may mean that less frequent impacts of RAS were missed. Future work: Future research should include (1) exploring the transferability of guidance for effective teamwork to other surgical domains in which technology leads to the physical or perceptual separation of surgeon and team; (2) exploring the benefits and challenges of including realist methods in feasibility and pilot studies; (3) assessing the feasibility of using routine data to understand the impact of RAS on rare end points associated with patient safety; (4) developing and evaluating methods for whole-team training; and (5) evaluating the impact of different physical configurations of the robotic console and team members on teamwork.
    • A reassuring presence: An evaluation of Bradford District Hospice at Home service

      Lucas, Beverley J.; Small, Neil A.; Greasley, Peter; Daley, A. (2008)
      Within the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home. A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs) in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners. Postal questionnaires were sent to carers (n = 289), district nurses (n = 508) and GP's (n = 444) using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS) and qualitative data was analysed using grounded theory techniques. The data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care. Carers and health professionals welcomed the increased possibility of patients being cared for at home. The study identified the need to focus on improving skill levels of staff and on ensuring continuity of care.
    • Reciprocity and Burnout in Direct care Staff

      Rose, J.; Madurai, T.; Thomas, K.; Duffy, B.; Oyebode, Jan R. (2010)
    • Recommended Standards for the Routine Performance Testing of Diagnostic X-Ray Systems

      Institute of Physics and Engineering in Medicine; Scally, Andy J. (2005)
      This Report replaces IPEM Report 77 and provides essential guidance for anyone responsible for diagnostic X-Ray equipment. This document gives clear advice on which routine performance tests are essential and which are desirable, where to get information on how to do them, who should be doing them and how often they should be done. For many tests it also gives guidance as to when the results indicate further action should be taken. This second edition takes into account the introduction of new technologies in medical imaging including CR, DDR and image display devices.