The role of the Radiographer in osteoporosis and fracture prevention services - a narrative review

Evidence of expert clinical practice among nuclear medicine non-medical staff: a scoping review

OBJECTIVE

This scoping review concerns expertclinical practice (ECP) by nuclear medicine practitioners (NMP), encompassing radiographers, technologists and nurses. ECP is typically demonstrated by clinical skills with higher levels of autonomy and responsibility traditionally fulfilled by physicians. The Advanced Clinical Practice (ACP) framework by Health Education England (2017) specifies ECP as one aspect of advanced role progression. This scoping review aims to identify and categorise the extent and type of the existing NMP ECP evidence to support the establishment of Nuclear Medicine ACP.

METHODS

PubMed, Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline were searched for peer-reviewed literature published between 2001 and 2021 using extended and advanced practice as key terms alongside nuclear medicine and each NMP profession. Due to the sparsity of results, conference abstracts from prominent international societies were also searched. Studies were independently reviewed and graded for inclusion by four NMP.

RESULTS

Of the 36 studies that met the inclusion criteria, 80.6% were conference abstracts and 66.7% were single-centres studies. Commonly reported NM ECP activities included image interpretation, cardiac stressing and therapies. Less reported activities include ordering complementary diagnostic procedures, invasive procedures and physical examinations. The United Kingdom presented itself at the forefront of NMP ECP publications.

CONCLUSION

This study demonstrates evidence of NMP ECP across a variety of clinical roles. The dominance of conference abstracts highlights NMP ECP as an emerging area of role extension and a potential preference for information dissemination by NMP. Greater research into specific NMP ECP activities is required particularly studies of greater sample size and robusticity.

STAT3-mediated osteogenesis and osteoclastogenesis in osteoporosis

Osteoporosis is a common skeletal disease with marked bone loss, deterioration of the bone microstructure and bone fragility. An abnormal bone remodelling cycle with relatively increased bone resorption is the crucial pathophysiological mechanism. Bone remodelling is predominantly controlled by osteoblasts and osteoclasts, which are specialized cell types that are regulated by a variety of osteogenic and osteoclastic factors, including cytokines expressed within the bone microenvironment under local or systemic inflammatory conditions. Signal transducer and activator of transcription 3 (STAT3) plays a prominent role in the communication between cytokines and kinases by binding downstream gene promotors and is involved in a wide range of biological or pathological processes. Emerging evidence suggests that STAT3 and its network participate in bone remodelling and the development of osteoporosis, and this factor may be a potent target for osteoporosis treatment. This review focuses on the role and molecular mechanism of the STAT3 signalling pathway in osteogenesis, osteoclastogenesis and osteoporosis, particularly the bone-related cytokines that regulate the osteoblastic differentiation of bone marrow stromal cells and the osteoclastic differentiation of bone marrow macrophages by initiating STAT3 signalling. This review also examines the cellular interactions among immune cells, haematopoietic cells and osteoblastic/osteoclastic cells.