Working as a musculoskeletal radiologist in India and in the UK: Similarities and differences in daily professional engagements

2021 ◽  
Vol 3 ◽  
pp. 30-33
Author(s):  
Srikanth Narayanaswamy ◽  
Siddharth Thaker ◽  
Harun Gupta ◽  
Rajesh Botchu
Keyword(s):  
Extended Family ◽  
Clinical Care ◽  
Complex Interventions ◽  
Work Hours ◽  
Work Time ◽  
Radiology Reports ◽  
Medical Institutions ◽  
Management Leadership ◽  
Academic Management ◽  
The Uk

A UK-trained musculoskeletal (MSK) radiologist relocating back to India may face numerous challenges while setting up subspecialty MSK radiology services. The National Health Service (NHS) and the Indian healthcare system are inherently different from each other in finance, governance, administration, and clinical services provision. The NHS can offer numerous opportunities to an MSK radiologist, including a diverse case mixture, protected work time divided between direct clinical care and supporting professional – academic, management, leadership, and continuous professional development – activities, flexible work hours, five days a week work pattern, continuous reflective learning from missed findings, and opportunities for advanced training in MSK tumour work and complex interventions. Indian MSK radiology services, compared to the NHS, are relatively curtailed and limited to metro cities with very few centres offering dedicated MSK imaging services and image-guided interventions. From an economic perspective, MSK radiologists in both countries earn more or less similar, given high taxation rates in the UK. Although Indian radiologists may face pressures to provide rapid radiology reports from the management, patients, and relatives, one can enjoy better image quality, liberty to customize scans, ease to start new intervention services, necessary breaks during work hours, and extended family support. A re-relocated MSK radiologist can survive and thrive in Indian healthcare, primarily corporate medical institutions, if one can strike a balance between professional and personal life.

scholarly journals Can the completeness of radiological cancer staging reports be improved using proforma reporting? A prospective multicentre non-blinded interventional study across 21 centres in the UK

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e018499 ◽  
Author(s):  
Anisha Patel ◽  
Andrea Rockall ◽  
Ashley Guthrie ◽  
Fergus Gleeson ◽  
Sylvia Worthy ◽  
...  
Keyword(s):  
Reporting Quality ◽  
Cancer Staging ◽  
Quality Standard ◽  
Interventional Study ◽  
Radiology Reports ◽  
Before And After ◽  
Diagnosis Of Cancer ◽  
Detailed Assessment ◽  
Uk National Health Service ◽  
The Uk

ObjectivesFollowing a diagnosis of cancer, the detailed assessment of prognostic stage by radiology is a crucial determinant of initial therapeutic strategy offered to patients. Pretherapeutic stage by imaging is known to be inconsistently documented. We tested whether the completeness of cancer staging radiology reports could be improved through a nationally introduced pilot of proforma-based reporting for a selection of six common cancers.DesignProspective interventional study comparing the completeness of radiology cancer staging reports before and after the introduction of proforma reporting.SettingTwenty-one UK National Health Service hospitals.Participants1283 cancer staging radiology reports were submitted.Main outcome measuresRadiology staging reports across the six cancers types were evaluated before and after the implementation of proforma-based reporting. Report completeness was assessed using scoring forms listing the presence or absence of predetermined key staging data. Qualitative data regarding proforma implementation and usefulness were collected from questionnaires provided to radiologists and end-users.ResultsElectronic proforma-based reporting was successfully implemented in 15 of the 21 centres during the evaluation period. A total of 787 preproforma and 496 postproforma staging reports were evaluated. In the preproforma group, only 48.7% (5586/11 470) of key staging items were present compared with 87.3% (6043/6920) in the postproforma group. Thus, the introduction of proforma reporting produced a 78% improvement in staging completeness . This increase was seen across all cancer types and centres. The majority of participants found proforma reporting improved cancer reporting quality for their clinical practice .ConclusionThe implementation of proforma reporting results in a significant improvement in the completeness of cancer staging reports. Proforma-based assessment of cancer stage enables objective comparisons of patient outcomes across centres. It should therefore become an auditable quality standard for cancer care.

scholarly journals ABCD position statement on risk stratification of adult patients with diabetes during COVID-19 pandemic

2021 ◽  
Author(s):  
Dinesh Nagi ◽  
Emma Wilmot ◽  
Karissa Owen ◽  
Dipesh Patel ◽  
Lesley Mills ◽  
...  
Keyword(s):  
Diabetes Care ◽  
Clinical Care ◽  
Position Statement ◽  
Specialist Care ◽  
Long Term Conditions ◽  
Use Of Technology ◽  
Patients With Diabetes ◽  
Long Term Impact ◽  
The Uk

At the time of submission of this manuscript, the COVID-19 pandemic had cost nearly 60,000 lives in the UK. This number currently stands at over 120,000 deaths. A high proportion (one third) of these lived with diabetes. The huge acute and emergency medicine effort to support people with COVID-19 has had a major knock-on impact on the delivery of routine clinical care, especially for long-term conditions like diabetes.Challenges to the delivery of diabetes services during this period include a reduction in medical and nursing staff, limitations placed by social distancing on physical clinical space, and balancing virtual vs face-to-face care. There is a need to re-group and re-organise how we deliver routine out-patient adult diabetes services during the ongoing COVID-19 pandemic. We offer some suggestions for how patients can be stratified into red (urgent), amber (priority) and green (routine) follow up with suggestions of how often people should be seen. We also offer recommendation on how we can identify those at highest risk and try and minimise the long- term impact of COVID on diabetes careDuring the COVID pandemic we have seen things happen in days that previously took years. The restart of diabetes services has triggered a more widespread use of virtual consultations and data management systems, but also offers an opportunity for more joined-up and cohesive working between primary and specialist care. While we do our best to keep our patients and colleagues safe, this pandemic is already proving to be a catalyst for change, accelerating the appropriate use of technology in diabetes care and implementing innovative solutions. To achieve this aspiration, further work – currently led by the Association of British Clinical Diabetologists in collaboration with Diabetes UK and the Primary Care Diabetes Society – to make recommendations on future proofing diabetes care in UK is in progress.

scholarly journals Preparing Clinical Text for Use in Biomedical Research

2011 ◽  
pp. 2085-2095
Author(s):  
John P. Pestian ◽  
Lukasz Itert ◽  
Charlotte Andersen
Keyword(s):  
Language Processing ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Text ◽  
Delivery Of Care ◽  
Radiology Reports ◽  
Academic Medical ◽  
Textual Data ◽  
Regulatory Actions

Approximately 57 different types of clinical annotations construct a patient’s medical record. These annotations include radiology reports, discharge summaries, and surgical and nursing notes. Hospitals typically produce millions of text-based medical records over the course of a year. These records are essential for the delivery of care, but many are underutilized or not utilized at all for clinical research. The textual data found in these annotations is a rich source of insights into aspects of clinical care and the clinical delivery system. Recent regulatory actions, however, require that, in many cases, data not obtained through informed consent or data not related to the delivery of care must be made anonymous (as referred to by regulators as harmless), before they can be used. This article describes a practical approach with which Cincinnati Children’s Hospital Medical Center (CCHMC), a large pediatric academic medical center with more than 761,000 annual patient encounters, developed open source software for making pediatric clinical text harmless without losing its rich meaning. Development of the software dealt with many of the issues that often arise in natural language processing, such as data collection, disambiguation, and data scrubbing.

scholarly journals AngelChik Device Removal and Revisional Fundoplication

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Hannah Chase ◽  
Sotiris Mastoridis ◽  
Nicholas Maynard
Keyword(s):  
Surgical Intervention ◽  
Clinical Care ◽  
Surgical Techniques ◽  
Developed Countries ◽  
Late Complications ◽  
Biliary Leak ◽  
Proactive Approach ◽  
Uncertain Evidence ◽  
Lower Oesophagus ◽  
The Uk

Gastro-oesophageal reflux disease (GORD) is a common condition in developed countries with an increasing incidence in the UK, currently estimated at 5 per 1000 person-years. Risk factors for GORD include Helicobacter pylori infection, obesity, alcohol consumption, smoking and genetic predisposition.  Surgical management is performed in chronic, severe cases of GORD, refractory to medical management. There are a variety of interventional surgical techniques available and the patient in this case had placement of an AngelChik Device (AD) 30 years ago. This is now a historic device due to associated complications and this patient had it removed with revisional treatment of the patient’s GORD with Nissen Fundoplication. The patient experienced multiple post-surgical complications, namely biliary leak from the central port, pulmonary embolism and pneumonia. Following description of the case, this report will discuss the increasing incidence of late complications of AD and propose a proactive approach to these patients going forwards. It will also discuss the current uncertain evidence of a new surgical intervention called magnetic sphincter augmentation (MSA) of the lower oesophagus that has similar principles to the mechanism of an AD. From this it will emphasise that more stringent and worldwide collaboration is required when bringing a new medical device into clinical care.

A survey of practice in the management of haemolysis, icterus, and lipaemia in blood specimens in the United Kingdom and Republic of Ireland

2021 ◽  
pp. 000456322110597
Author(s):  
Sean Costelloe ◽  
Natividad Rico Rios ◽  
Nicola Goulding ◽  
Hema Mistry ◽  
Adam Stretton ◽  
...  
Keyword(s):  
Quality Control ◽  
Clinical Care ◽  
Laboratory Medicine ◽  
Cross Reactivity ◽  
Public Hospitals ◽  
Internal Quality ◽  
The United Kingdom ◽  
Blood Specimens ◽  
The Uk ◽  
Control And Management

Background Haemolysis, icterus and lipaemia (HIL) are common interferants in laboratory medicine, potentially impacting patient care. This survey investigates HIL management in medical laboratories across the UK and ROI. Methods A survey was sent to members of key professional organisations for laboratory medicine in the UK and ROI. Questions related to the detection, monitoring, quality control, and management of HIL. Results In total, responses from 124 laboratories were analysed, predominantly from England (52%) and ROI (36%). Most responses were from public hospitals with biochemistry services (90%), serving primary care (91%), inpatients (91%), and outpatients (89%). Most laboratories monitored H (98%), I (88%), and L (96%) using automated indices (93%), alone or in combination with visual inspection. Manufacturer-stated cut-offs were used by 83% and were applied to general chemistries in 79%, and immunoassays in 50%. Where HIL cut-offs are breached, 64% withheld results, while 96% reported interference to users. HIL were defined using numeric scales (70%) and ordinal scales (26%). HIL targets exist in 35% of laboratories, and 54% have attempted to reduce HIL. Internal Quality Control for HIL was lacking in 62% of laboratories, and just 18% of respondents have participated in External Quality Assurance. Laboratories agree manufacturers should: standardise HIL reporting (94%), ensure comparability between platforms (94%), and provide information on HIL cross-reactivity (99%). Respondents (99%) showed interest in evidence-based, standardised HIL cut-offs. Conclusions Most respondents monitor HIL, although the wide variation in practice may differentially affect clinical care. Laboratories seem receptive to education and advice on HIL management.

scholarly journals Temporal features of sitting, standing and stepping changes in a cluster-randomised controlled trial of a workplace sitting-reduction intervention

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Samantha K. Stephens ◽  
Elisabeth A. H. Winkler ◽  
Elizabeth G. Eakin ◽  
Bronwyn K. Clark ◽  
Neville Owen ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Work Hours ◽  
Trial Registration ◽  
Sitting Time ◽  
Work Time ◽  
Prolonged Sitting ◽  
Cluster Randomised ◽  
Randomised Controlled

Abstract Background There is now a body of evidence on the effectiveness of interventions to reduce workplace sitting time. However, there has been limited reporting of how such interventions may impact behaviour both during and outside of work. Sitting, standing and stepping changes following a workplace intervention were examined across five timeframes (work time on work days; non-work time on work days; work days; non-work days; overall (i.e. work and non-work time on all days)), and the relationships between changes during and outside of work was assessed. Methods The cluster-randomised controlled trial, ‘Stand Up Victoria’, delivered a multi-component workplace-delivered intervention that successfully reduced workplace and overall sitting time (relative to controls). Separately, over the five timeframes, changes in device (activPAL3)-assessed outcomes — sitting; prolonged sitting (≥30 min bouts); standing; and, stepping — were compared between intervention (n = 114) and controls (n = 84), along with the time-course of sitting changes during work hours, using mixed models. The potential relationships of changes during work with changes outside of work were examined using compositional data analysis. Results On workdays, intervention participants significantly (p < 0.05) improved their activity profile relative to controls, with reduced sitting (− 117 min/8-h workday, 95% CI: − 141, − 93) and prolonged sitting (− 77 min/8 h workday, 95% CI: − 101, − 52); increased standing (114 min/8 h workday, 95% CI: 92, 136) and maintenance of stepping (3 min/8 h workday, 95% CI: − 7, 11, p = 0.576). Effects were nearly identical for time at work; similar but slightly weaker for overall; and, small and non-significant outside of work on workdays and non-work days. Improvements occurred at all times, but not equally, during work hours (p < 0.001). Correlations between changes during and outside of work on workdays were very weak in both the intervention group (r = − 0.07) and controls (r = − 0.09). Conclusions Sitting time was reduced almost exclusively during work hours (via replacement with standing), with reductions evident during all working hours, to varying degrees. There was no evidence of compensation, with minimal change in activity outside of work, in response to changes in activity at work. Future interventions may benefit from exploring how best to elicit change throughout the whole day, and across work and non-work domains. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials register (ACTRN12611000742976) on 15 July 2011

Defence Clinical Psychology Service: an overview of clinical psychology in the UK Ministry of Defence

2018 ◽  
Vol 165 (2) ◽  
pp. 71-73
Author(s):  
Rachel Norris ◽  
M McCauley
Keyword(s):  
Future Development ◽  
Clinical Psychology ◽  
Clinical Care ◽  
Armed Forces ◽  
Healthcare Organisation ◽  
Joint Forces ◽  
Psychology Service ◽  
Care Consultation ◽  
Professional Leadership ◽  
The Uk

The Defence Clinical Psychology Service (DCPS) is the professional clinical psychology service and community of clinical psychology practice within UK Ministry of Defence (MoD). The DCPS provides professional clinical care, consultation and research in support of the UK Armed Forces. Regulated by the Health and Care Professions Council, DCPS psychologists are employed as Crown (Civil) Servants within the MoD. Serving as assets of Joint Forces Command within the Defence Primary Healthcare organisation, the professional leadership for such personnel is provided by the office of the Defence Consultant Advisor (DCA) for clinical psychology. The following paper offers an overview of the history, service context, training and mission of the DCPS. Areas for future development are also considered.

scholarly journals Clinical characteristics and care pathways of patients with personality disorder who died by suicide

BJPsych Open ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Sandra Flynn ◽  
Jane Graney ◽  
Thabiso Nyathi ◽  
Jessica Raphael ◽  
Seri Abraham ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Clinical Care ◽  
Case Series ◽  
Drug Misuse ◽  
Care Pathways ◽  
Short Term ◽  
Psychological Therapies ◽  
Patient Admissions ◽  
History Of ◽  
The Uk

Background It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments. Aims To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance. Method National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK. Results The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients. Conclusions Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.

scholarly journals Corporate Governance Practices in Higher Education Institutions: The UK vs Bahrain

2018 ◽  
Vol 8 (4) ◽  
pp. 29
Author(s):  
Marwan M. Abdeldayem ◽  
Saeed H. Aldulaimi
Keyword(s):  
Higher Education ◽  
Arab World ◽  
Educational Institutions ◽  
Education Governance ◽  
Academic Management ◽  
Governance Practices ◽  
Governance In Higher Education ◽  
The Uk ◽  
Higher Education Organizations ◽  
Different Cultures

This research aims to investigate the application of leadership and governance in higher education organizations in the Kingdom of Bahrain and the UK. The study also intends to gather evidences on the practices of academic management in different cultures. The methods of the study relies on reading lists of governance standards from several advanced educational institutions and uses a “comparative methodology” based on the data from the Kingdom of Bahrain and The UK. This research reviews the various models of “the higher education governance” and discuss the strengths and weaknesses of each model. The study employs the three principles of UNDP (Transparency, Participation and Accountability) to assess application of leadership and governance in higher education institutions.The findings of this study reveal that Arab universities need to perceive the significance of clarifying the reason for governance. The examination likewise distinguishes the significance of relating their job and commitment to the procedure of change to the learning based economy and world informatics. Also, it features the need of broadening the cooperation of stakeholders in the key basic leadership.The importance of this study lies in examining whether the governance standards are associated with practical application in universities. Also it examines whether there is an influence of the culture and social aspects on the application and understanding of these standards. The significance of receiving administration measures in the Arab world lies in its possibility to change the HE organizations’ practices, and increment their ability for greatness and aggressiveness. Thus, ensures the autonomy of advanced education alongside its quality and viability particularly with respect to their yield and status locally and internationally. 

scholarly journals Interactive NLP in Clinical Care: Identifying Incidental Findings in Radiology Reports

2019 ◽  
Vol 10 (04) ◽  
pp. 655-669
Author(s):  
Gaurav Trivedi ◽  
Esmaeel R. Dadashzadeh ◽  
Robert M. Handzel ◽  
Wendy W. Chapman ◽  
Shyam Visweswaran ◽  
...  
Keyword(s):  
Language Processing ◽  
Gold Standard ◽  
Incidental Findings ◽  
User Study ◽  
Clinical Care ◽  
Model Performance ◽  
Data Set ◽  
Radiology Reports ◽  
System Usability Scale ◽  
And Control

Abstract Background Despite advances in natural language processing (NLP), extracting information from clinical text is expensive. Interactive tools that are capable of easing the construction, review, and revision of NLP models can reduce this cost and improve the utility of clinical reports for clinical and secondary use. Objectives We present the design and implementation of an interactive NLP tool for identifying incidental findings in radiology reports, along with a user study evaluating the performance and usability of the tool. Methods Expert reviewers provided gold standard annotations for 130 patient encounters (694 reports) at sentence, section, and report levels. We performed a user study with 15 physicians to evaluate the accuracy and usability of our tool. Participants reviewed encounters split into intervention (with predictions) and control conditions (no predictions). We measured changes in model performance, the time spent, and the number of user actions needed. The System Usability Scale (SUS) and an open-ended questionnaire were used to assess usability. Results Starting from bootstrapped models trained on 6 patient encounters, we observed an average increase in F1 score from 0.31 to 0.75 for reports, from 0.32 to 0.68 for sections, and from 0.22 to 0.60 for sentences on a held-out test data set, over an hour-long study session. We found that tool helped significantly reduce the time spent in reviewing encounters (134.30 vs. 148.44 seconds in intervention and control, respectively), while maintaining overall quality of labels as measured against the gold standard. The tool was well received by the study participants with a very good overall SUS score of 78.67. Conclusion The user study demonstrated successful use of the tool by physicians for identifying incidental findings. These results support the viability of adopting interactive NLP tools in clinical care settings for a wider range of clinical applications.

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