"I think this could be a big success" - A mixed methods study on practitioner perspectives on the acceptance of a virtual reality tool for preparation in MRI

INTRODUCTION

A key part of a radiographer's role within MRI is providing the required emotional support to help patients succeed with a scan. Being informed is important; whilst information leaflets and videos are commonly used, these can be limited in their representation of the experience. Virtual reality tools are being shown to reasonably replicate a scan experience, having a positive impact on patient satisfaction and anxiety. The aim was to obtain the views of practitioners on the use and implementation of such a tool in practice.

METHODS

A mixed methods study was conducted looking at the use of a virtual scan experience for patients prior to MRI. Nine radiographers attended two focus group sessions to see the tool and undergo a virtual experience. Following this, a survey based on the technology acceptance model was completed along with a semi-structured discussion about its use.

RESULTS

Perceived usefulness, ease of use, attitude and intention to use were all positive towards the virtual scan tool. All practitioners saw value in such a tool and how it could be implemented within practice, highlighting areas for improvement and development.

CONCLUSION

The practitioner's perspective was that access to such a virtual scan experience could be of use to better prepare and support those patients needing extra support before a real scan. Acknowledgement of having time to discuss patient concerns was noted and this could provide a means of doing so away from busy scanning lists whilst not taking up additional time.

IMPLICATIONS FOR PRACTICE

Use of VR tools could be a conduit through which trust and rapport are built in advance away from busy scanning lists, thereby not impacting on operational throughput and hindering efficiency.

Review of claustrophobia incidence in MRI: A service evaluation of current rates across a multi-centre service

INTRODUCTION

Magnetic Resonance Imaging remains an anxious experience for many, often exhibiting as fear of enclosed spaces. A useful metric to assess its prevalence and impact in practice is premature termination due to claustrophobia. Incidence varies and depends on many factors such as the physical nature of the imaging equipment and examination being undertaken, as well as the patient themselves.

METHODS

Scan appointment data from between April 2019-March 2021 was extracted and reviewed. Analysis included the type of scanner used, patient age, sex, examination area, funding source, attendance and completion status. Binomial logistic regression was performed to look for any relevant predictors of failure to scan due to claustrophobia.

RESULTS

Overall incidence of incomplete examinations due to claustrophobia was 0.76%. Whilst the majority of scans were performed on conventional systems, those undergoing Open scans were over three times more likely to fail a scan due to claustrophobia, whilst those undergoing UpRight scanning were half as likely. Likelihood of claustrophobia increases with females, those between 45-64years of age, funded by the NHS and entering the scanner head first or having a head scan.

CONCLUSION

Incidence of incomplete scanning is below 1% but with the potential for further reduction with implementation and use of improved scanner design and technology. Understanding the impact of other variables is also useful to raise awareness of those at greater risk of claustrophobia. However, there are wider influences beyond data alone to consider and account for.

IMPLICATIONS FOR PRACTICE

Whilst occurrence of claustrophobia is low, there remains a cost impact, as well as an importance in understanding the patient experience. Drawing on operational data can help provide a limited, generalised view to support service improvement.

Radiographer Perspectives on current occurrence and management of claustrophobia in MRI

INTRODUCTION

Magnetic Resonance Imaging (MRI) is well known to be a source of anxiety for patients, commonly appearing as claustrophobia. One of the main reasons for this is due to the physical nature of the scanner itself. Despite technological improvements, there is lacking evidence on whether these improvements have resulted in a reduction in claustrophobia and anxiety in the clinical setting. Background anxiety associated with the current COVID-19 pandemic may also have shown an increase in prevalence. Therefore, the aim of this study was to survey MRI radiographers on their perspectives on the occurrence and management of claustrophobia in modern day clinical practice.

METHODS

Following ethical approval, an online survey was used to gather the opinions of MRI radiographers. This used closed ranking questions as well as open responses to gain insight into how this issue may be presenting in practice, preferences in management, and barriers to providing support.

RESULTS

Responses provide an up-to-date view on how radiographers perceive both displays of anxiety and associated impacts on patient outcome, the considered sources of anxiety, the use and effectiveness of support strategies, barriers to providing this support, and views on how COVID-19 has impacted on practice.

CONCLUSION

The study provides a current view from radiographers on their experience of claustrophobia in practice. It shows that this remains a regular part of practice within the modality. Therefore, for MRI radiographers managing this is an essential component of their role. Communication and interaction with the patient are recognised as important, although time is a barrier to always being able to provide patient centred care.

IMPLICATIONS FOR PRACTICE

Ongoing support is needed for both patients and radiographers to improve experience within MRI.

Scoping review: How is virtual reality being used as a tool to support the experience of undergoing Magnetic resonance imaging?

OBJECTIVES

Undergoing a Magnetic Resonance Imaging (MRI) scan continues to be a source of anxiety and concern for many patients. Various interventions have been developed and are used in regular clinical practice to support patients through the procedure. A novel approach which is gaining traction is that of virtual reality (VR) as a tool to support patient experience in MRI. This scoping review considers how it is currently being used and developed and discusses how effective it may be.

KEY FINDINGS

The eight papers found show a range of approaches being used; as a preparatory tool, exposure therapy or distraction technique. All of which show general positive influence on patient anxiety, compliance, and acceptability. The more recent, but limited number of papers, show this to be a developing field.

CONCLUSION

The potential for the use of VR lies in its ability to closely replicate the real world as a preparatory and exposure technique for those likely to experience concerns over the MRI procedure itself. The reality of the virtual environment also provides opportunity to spend time coaching patients in advance without the need to take up actual scanner time, thereby providing a safe space in which preparation and support can be given.

IMPLICATIONS FOR PRACTICE

It is argued that a better understanding of the theoretical basis on which VR may be working would further help development and implementation in clinical practice. This could then support a truly patient-centred approach to management of claustrophobia and associated anxieties related to MRI.

Distinct post-translational features of type I collagen are conserved in mouse and human periodontal ligament

BACKGROUND AND OBJECTIVE

Specifics of the biochemical pathways that modulate collagen cross-links in the periodontal ligament (PDL) are not fully defined. Better knowledge of the collagen post-translational modifications that give PDL its distinct tissue properties is needed to understand the pathogenic mechanisms of human PDL destruction in periodontal disease. In this study, the post-translational phenotypes of human and mouse PDL type I collagen were surveyed using mass spectrometry. PDL is a highly specialized connective tissue that joins tooth cementum to alveolar bone. The main function of the PDL is to support the tooth within the alveolar bone while under occlusal load after tooth eruption. Almost half of the adult population in the USA has periodontal disease resulting from inflammatory destruction of the PDL, leading to tooth loss. Interestingly, PDL is unique from other ligamentous connective tissues as it has a high rate of turnover. Rapid turnover is believed to be an important characteristic for this specialized ligament to function within the oral-microbial environment. Like other ligaments, PDL is composed predominantly of type I collagen. Collagen synthesis is a complex process with multiple steps and numerous post-translational modifications including hydroxylation, glycosylation and cross-linking. The chemistry, placement and quantity of intermolecular cross-links are believed to be important regulators of tissue-specific structural and mechanical properties of collagens.

MATERIAL AND METHODS

Type I collagen was isolated from several mouse and human tissues, including PDL, and analyzed by mass spectrometry for post-translational variances.

RESULTS

The collagen telopeptide cross-linking lysines of PDL were found to be partially hydroxylated in human and mouse, as well as in other types of ligament. However, the degree of hydroxylation and glycosylation at the helical Lys87 cross-linking residue varied across species and between ligaments. These data suggest that different types of ligament collagen, notably PDL, appear to have evolved distinctive lysine/hydroxylysine cross-linking variations. Another distinguishing feature of PDL collagen is that, unlike other ligaments, it lacks any of the known prolyl 3-hydroxylase 2-catalyzed 3-hydroxyproline site modifications that characterize tendon and ligament collagens. This gives PDL a novel modification profile, with hybrid features of both ligament and skin collagens.

CONCLUSION

This distinctive post-translational phenotype may be relevant for understanding why some individuals are at risk of rapid PDL destruction in periodontal disease and warrants further investigation. In addition, developing a murine model for studying PDL collagen may be useful for exploring potential clinical strategies for promoting PDL regeneration.

A feasibility study of an intensive combined modality smoking cessation program in the radiation oncology clinic

19604

Background: Radiotherapy (RT) patients present for daily treatment over many weeks, often accompanied by friends and family. This represents a unique opportunity for intensive smoking intervention concurrently with RT in both cancer patients and their companions. Methods: Eligible participants included smoking cancer patients scheduled to receive = 3 weeks of RT and their smoking family/friends. All participants received bupropion and 9 individualized behavioral interventions (BI) in the RT clinic with an addiction professional, followed by 9–12 scheduled intensive relapse prevention encounters (in person or by telephone). The primary endpoint was feasibility determined by accrual and program completion. Other endpoints included carbon-monoxide (CO) confirmed and participant-reported tobacco abstinence. During 4 months of enrollment, smoking and basic eligibility data were prospectively collected on consultations seen in clinic. Results: Over 8 months 20 cancer patients and 3 family members were enrolled. Based on our sampling, this represented greater than 40% of eligible smokers seen in clinic. Six cancer patients withdrew, all on or before the third BI. 13 participants completed all 9 BIs while 4 patients completed 7–8 BIs. 11 participants reported compliance with bupropion therapy. One participant discontinued bupropion citing increased depression. No other possible adverse events to bupropion or BI were discovered. At the completion of BI, 16 participants had exhaled CO concentrations < 10ppm and 14 participants self-reported tobacco abstinence. Of the 17 participants completing 7–9 behavioral interventions, the median number of relapse prevention sessions was 4 (range 0–8). With a median follow-up of 5.85 months, the 3-month crude self-reported abstinence rate was 41% (7/17). Conclusions: Tobacco cessation with bupropion and intensive BI for cancer patients and their companions during RT was feasible. A significant number of eligible smokers enrolled and completed BI during RT. However, few participants completed scheduled prevention encounters following RT.

No significant financial relationships to disclose.

Severe prothrombin deficiency caused by prothrombin-Edmonton (R-4Q) combined with a previously undetected deletion

BACKGROUND

During infancy, a male patient experienced several life-threatening bleeding episodes. Standard coagulation tests revealed that the patient's plasma prothrombin activity was 8%, while his father's and mother's levels were 74% and 62%, respectively.

OBJECTIVES

A molecular genetic approach was used to determine the molecular basis of prothrombin deficiency within the family.

PATIENT/METHODS

Prothrombin genomic DNA fragments were amplified by using the polymerase chain reaction (PCR). In addition, liver cDNA fragments were amplified from the patient by using reverse transcription (RT) and PCR. The nucleotide sequences of the DNA fragments were determined.

RESULTS

A novel, heterozygous point mutation (g.1755 G > A, named prothrombin-Edmonton) was detected in the patient and his mother, resulting in the mutation of Arg-4 in the prothrombin propeptide to Gln (R-4Q). RT-PCR analysis of the patient's liver sample demonstrated the presence of two mRNA transcripts that differed by the presence or absence of exon 11. Real-time PCR analysis on genomic DNA and cDNA confirmed a deletion (g.10435_10809del) in the paternal allele.

CONCLUSIONS

The patient has a maternally-inherited point mutation (R-4Q) and a paternally-inherited deletion. By analogy with the previously reported factor IX San Dimas, the R-4Q mutation probably causes under-carboxylation of prothrombin and poor cleavage of the propeptide in the hepatocyte. The deletion probably results in a polypeptide that lacks 50 amino acids from the protease domain; this is likely to impair folding, secretion, stability and/or activity of the truncated prothrombin. The two mutations combine to give the prothrombin deficiency observed in the patient.

Cloning and characterization of the Atlantic salmon serum lectin, a long-form C-type lectin expressed in kidney

We report the cloning of four distinct cDNAs and a genomic sequence encoding a multimeric serum lectin found in the blood of Atlantic salmon (Salmo salar). The sequence variation among the cDNAs as well as genomic Southern blotting analysis revealed a multi-gene family. Expression of the salmon serum lectin (SSL) was specific to kidney, as demonstrated by RT-PCR. Analysis of the 173-amino acid sequence of SSL confirmed that it is a member of the C-type lectin superfamily. Sequence alignments and intron/exon structure of the SSL gene showed it to belong to the type VII C-type lectins, which normally bind to galactose or other ligands, whereas the SSL protein sequence contains the EPN motif of mannose-binding C-type lectins, that bind mannose or related carbohydrates.

Paraspinal electromyography in high lumbar and thoracic lesions

OBJECTIVE

To use needle electromyography in the paraspinal muscles to localize the root level of a radiculopathy.

DESIGN

We collected nine cases of clinically proven, isolated high lumbar or thoracic disk herniations of patients who underwent MiniPM. Four were from a prospective study of 114 persons with low back pain (MiniPM had 100% sensitivity to magnetic resonance imaging-documented high disks).

RESULTS

In the most medial "S" column, mean MiniPM scores were 0.7 for the level above the radiologically documented lesion; 3.1 at the lesion; and 1.6, 1.6, and 1.1 at the three spinous processes below the lesion. Similar numbers were obtained in the "M" column (slightly lateral), with no significant differences between S and M. Differences were significant between and at the level of the lesion for S (P < 0.06) and M (P < 0.01), and between the lesion level and three levels below for the M column (P < 0.01).

CONCLUSIONS

These findings suggest that paraspinal electromyography has a higher than previously reported sensitivity for high lumbar lesions. Electromyography using MiniPM can localize some radiculopathies. The individual cases suggest that, consistent with the anatomy of the caudi equina, thoracic lesions and lateral lumbar lesions denervate only at one level, but more central lumbar lesions also denervate distally innervated paraspinal muscles.

Chart reminders increase referrals for inpatient smoking cessation intervention

The purpose of this study was to test the effect of a chart reminder system on referral of inpatients to a hospital smoking cessation intervention pilot program. An A1-B-A2 reversal design was used to test the hypothesis that a chart reminder to nursing staff would increase the proportion of smokers referred for smoking cessation intervention over the usual method of posted memos. In Condition A1, memos reminding nursing staff to refer smokers were posted prominently on a cardiopulmonary unit for 4 weeks. In Condition B, a reminder containing the same message was placed in the front of every patient chart for 4 weeks. Finally, in Condition A2, chart reminders were removed and posted memos were reinstated for 4 additional weeks. During Condition A1 (posted memo), only one patient out of 29 eligible smokers was referred, for a referral rate of 3.4%. In Condition B (chart reminders), 18 patients out of 52 (34.6%) were referred (chi 2 = 10.07, p < 0.01). In Condition A2, the referral rate returned to below baseline (2.1%) (chi 2 = 16.80, p < 0.001). The findings support the use of a chart reminder system for screening and referral as an important component for comprehensive smoking cessation programs in the acute care setting.

Physiologic and clinicopathologic effects of crude oil on loggerhead sea turtles

The physiologic and clinicopathologic effects of weathered South Louisiana crude oil exposure were studied in the laboratory in juvenile loggerhead sea turtles. Sea turtles ingested oil incidentally, and oil was observed clinging to the nares, eyes, and upper esophagus, and was found in the feces. Oiled turtles had up to a four-fold increase in white blood cell counts, a 50% reduction in red blood cell counts, and red blood cell polychromasia. Most serum blood chemistries (e.g., BUN, protein) were within normal ranges, although glucose returned more slowly to baseline values than in the controls. Gross and histologic changes were present in the skin and mucosal surfaces of oiled turtles, including acute inflammatory cell infiltrates, dysplasia of epidermal epithelium, and a loss of cellular architectural organization of hte skin layers. The cellular changes in the epidermis are of particular concern because they may increase susceptibility to infection. Although many of the observed physiological insults resolved with a 21-day recovery period, the long-term biological effects of oil on sea turtles remain completely unknown.

Cortical acetylcholine efflux with hypercapnia and nociceptive stimulation

In rabbits anesthetized with 70% N2O-30% O2, the rate of efflux of acetylcholine (ACh) from the cerebral cortex doubled during hypercapnia (increase of end-tidal CO2 from 4 to 8%), and during mild nociceptive stimulation of the tail. Under 0.7% halothane anesthesia, the control rate of ACh efflux was lower than that under N2O; the rate rose 2-fold during hypercapnia and 4-fold during tail stimulation. In the absence of systemic atropinization, increase in ACh efflux was correlated with a shift in EEG from high- to low-voltage ('activated'); after systemic atropinization EEG remained in the high-voltage state, but the changes in ACh efflux with hypercapnia and stimulation were not affected. Following transection of the midbrain, ACh efflux was markedly depressed and did not change during hypercapnia. Taken in context with the previously known facts that the cerebral hyperemia of hypercapnia is potentiated by cholinesterase inhibition and attenuated by atropine or decerebration, the present results support the concept of a cholinergic regulation of the cerebral vasculature.

Gas exchange and energy cost of flight in the white-necked raven, Corvus cryptoleucus

Energy expenditure during steady-state, wind tunnel flights was estimated from O2 and CO2 exchange in five white-necked ravens (Corvus cryptoleucus, mean mass, 0.48 kg) at air speeds of 8–11 m/s. Power input was closely similar to allometric predictions based on data from other species of smaller birds. It increased significantly with air speed and flight angle above horizontal, and decreased with increasing angles below horizontal. Maximum power input reached seven times the preflight value measured under resting but not basal conditions, 14 times the previously measured basal values and three times the calculated maximum for a similar sized running mammal. Energy cost to travel 1 km decreased with increasing air speed. These trends are similar to those previously observed in smaller birds.

Remarkable blood catecholamine levels in forced dived ducks

Levels of circulating epinephrine (E) and nor-epinephrine (NE) were measured in duck blood before, during, and after forced dives which were extended close to the limit of underwater endurance. Both E and NE increased by, on occasion, three orders of magnitude. After surfacing, plasma catecholamine levels fell rapidly. The reason for this enormous amine release in forced dived ducks remains a matter of speculation.

Nonsusceptibility of Lizards Exposed to the Entomopathogen Bacillus sphaericus

Tropical and subtropical lizards of the genus Anolis were exposed to Bacillus sphaericus Neide strain 1593-4, which has been proposed as a safe entomopathogen specific for mosquitoes. No deleterious effects were observed in lizards exposed to live bacteria through intraperitoneal injection or aerosol spray. Bacteria were lost quickly from lizard livers but were detectable at least 37 days after intraperitoneal injection.

Independence of brain and body temperatures in flying American kestrels, Falco sparverius

Brain and body temperatures were measured via small thermocouples implanted in the anterior hypothalami and colons, respectively, of five adult American kestrels (F. sparverius, mean mass 119 g) during descending flights in a wind tunnel at angles of 4 and 6 degrees below horizontal, at 10 m.s-1 air speed, and at 23 degrees C air temperature. For comparison, temperatures were recorded from resting birds at 22.5-36.1 degrees C air temperatures. Colonic (Tc) and hypothalamic (Th) temperatures both increased after the onset of flight; steady-state levels were attained after 1 min in the hypothalamus and after 5 or more min in the colon. The steady-state difference (delta T = Tc - Th) averaged 1.2 degrees C, higher by 0.5 degrees C than delta T in resting kestrels. The establishment of delta T during flight may be correlated with increased respiratory and corneal evaporation. The response apparently confines most stored body heat to noncranial regions, thus protecting brain tissue from thermal extremes.

Measurement of evaporative water loss in small animals by dew-point hygrometry

This paper presents the procedures and equations to be utilized for measurement of evaporative water loss (mw), by use of the dew-point hygrometer, in small animals exposed to air containing water vapor in an open-flow system. The system accounted accurately for the water evaporated from a bubble flask. In addition, hygrometric measurements of pulmocutaneous mw in pigeons (Columba livia, mean mass 0.31 kg) agreed closely with simultaneous gravimetric measurements, utilizing a desiccant in the sample stream, in a manner independently of air temperature (Ta, 20 or 40 degrees C), ambient water vapor pressure (PW, 4-16 10(2) Pa), or mw (5-66 mg-min-1). Evaporation in pigeons was independent of PW at 20 degrees C, but increased with decreasing PW at 40 degrees C, suggesting differences in ventilatory adjustments to changes in PW at the two temperatures.

Location of the Mup-a locus on mouse linkage group 8

By the use of pintail (Pt) and brown (b) as markers, the location of Mup-a, a locus controlling electrophoretic variation of one of the components of the major urinary protein (MUP) complex, on mouse linkage group VIII has been determined. The order and intervals determined from recombination frequencies in 121 offspring from a back-cross were Pt 4·1 b 6·6 Mup-a.

Linkage of one component of the major urinary protein complex of mice to the brown coat color locus

Two codominant alleles,Mup-a1andMup-a2, controlling electrophoretic variation of one of the components of the major urinary protein (MUP) complex of the mouseMus musculushave been found to be linked to the black–brown coat color alleles (linkage group VIII).