Difficulties associated with access to training and clinical support for Reporting Radiographers – A narrative evidence synthesis

ObjectivesThis narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on accessibility to training for prospective Reporting Radiographers as well as clinical support within and beyond training.Key findingsFifteen studies informed the themes of this article, they were published between 2014 and 2021. Reporting Radiographers often found it difficult find support during training and once qualified, this was usually due to the availability and workload of supervising staff. Although resistance and obstruction were experienced by many. Concerns relating to pay, promotion and interest were expressed by some respondents whilst access to courses and finance were highlighted as areas of variance across the UK.ConclusionInadequate support of Reporting Radiographers is impairing expansion of the specialism, whilst impacting capability and morale. This increases risk of patient harm, delays to care and inefficiency, it also threatens the sustainability of services. Negative interactions between Reporting Radiographers and Radiologists or managers is disappointing considering development of the specialism; evidence of Reporting Radiographer effectiveness and current collaboration between Royal College of Radiologists and Society of Radiographers. Issues raised in relation to pay/promotion and litigation could be clarified with ease, this should be considered when guidance is updated. Access to finance and courses is a major barrier in some regions of the UK. Scope exists for further exploration of training. England has used grants to facilitate uptake, these may prove to be an important tool in other countries.Implications for practiceDrivers to increase recruitment should be implemented alongside measures to facilitate accessibility to training and improvements to support infrastructure.     

Barriers and interventions for postpartum reclassification of glycemic status in women with gestational diabetes mellitus: A scoping review

Background and aimsOur aim was to summarize, analyze and disseminate the current state of knowledge about the barriers and facilitators in postpartum reclassification that women who have had gestational diabetes face.MethodsData collection was carried out from January to March 2021 in PubMed, Scopus, Web of Science (WoS), Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases.ResultsOf the 361 studies initially retrieved in the search, 32 articles published between 2010 and 2020 were selected because they were within our objective.ConclusionMultiple barriers and interventions were found regarding the reclassification of the glycemic status of women who had Gestational Diabetes during pregnancy. Therefore, further studies are needed to achieve a better intervention for this condition.     

Accessibilité, politiques inclusives et droit à l’éducation : considérations conceptuelles et méthodologiques

The right to education promoted by the United Nations’ Convention on the Rights of Disabled Persons aims at fighting against discriminations persons with disabilities face in this matter. Identifying existing discriminations require however reliable data allowing for analyzing education systems’ ability to provide Special Educational Needs students with equal opportunities in terms of access, success, prospects and affiliation. This article describes the conceptual framework developed to identify indicators required to monitor the implementation of right to education in the European Union building upon an OECD research made on the transition to higher education and to employment of SEN students.     

Création d’une consultation psychiatrique ouverte aux préparationnaires du 5e et du 6e arrondissement de Paris : retour d’activité sur l’année 2017–2018

Part of the French post-secondary education system is the Classes Préparatoires aux Grandes Écoles (High School Preparatory Classes) which consists of two intensive years (or three years sometimes) to pass the entrance examination of the Grandes Écoles. Grandes Écoles are highly selective, elite, and prestigious institutions [10]. The difficulties for these students are a higher stress (succeed the entrance examination), lack of time (all their time is dedicated to studies). The access to public psychiatric health system depends on where you live. Due to their schedule, they spend most of their time in the high school and they can’t consult in the psychological centre whom they depend [9]. In these conditions, in December 2017, public psychiatric care of the 5th and 6th districts of Paris created a psychiatric consultation in one high school opened to the students in Classes Preparatoires which signed a convention with the psychiatric ward.ObjectivesThis study aims to debrief the activity and the student profiles in the first year of this consultation.Patients and methodsThe patients are composed of students registered in Classes Préparatoires from the 5th and 6th district of Paris and who came to the psychiatric consultation, aged from 16 to 19 years old and referred by school nurses, school doctors, psychiatric ward or student himself. Retrospective study based on the activity of the consultation and medical files of psychiatrics consultations between December 2017 and July 2018.ResultsFifteen students consulted with a mean of 5.2 ± 2.9 consultations per students, eleven of them were oriented by school nurses. Eleven students benefited from a regular follow-up or an “in case of need” consultation. Five students had already received a psychotropic drug before the consultation; at the end of the year, ten of them received medication. The most prescribed category of medication are antidepressants and anxiolytics with seven patients apiece. The most represented disorders are a major depressive disorder (41%), adaptative disorder (29%), anxiety disorder (12%). Four students stopped their studies in the high school during the academic year. Two students needed to be hospitalized in the psychiatric ward of the district, they continued their education in their high school after hospitalization.ConclusionThe consultation for the Classes Préparatoires aux Grandes Écoles allowed an access to a psychiatric offer next to the place those students spend most of their time, without going to an emergency structure and with a shorter waiting time compared to the psychological centre in public health system. This consultation enables the evaluation, the follow-up and the orientation of the students, including the hospitalization when it is needed but also to sustain some students in their studies. In views of requesting a psychotherapy and the usual waiting time in the psychotherapeutic centre for students which already exist, there is important need to provide increased resources for these students.     

Le concept de responsivité : l’accessibilité comme moyen,la participation comme fin

Despite the legal requirements, many buildings and services, even recent ones, does not meet the needs of people with disabilities. By involving an association of people with disabilities, the analysis of the difficulties encountered in adapting both a new building and an old building to the needs of people with disabilities reveals that the notions of standards and accessibility do not allow the participation of persons with disabilities. To better take into account the demands of people with disabilities, this publication proposes to clearly separate the purpose of accessibility from the means used, by introducing the notion of “responsiveness”. From an interactionist perspective, responsiveness is the ability of an environment to respond to the human demand for participation. Indeed, improving the social participation of people with disabilities involves verifying whether the environment actually meets their demands.     

足头向穿刺路径在膈肌下方肝肿瘤消融治疗中的CT模拟测量研究

【摘要】 目的 对足头向穿刺路径进行模拟测量并评价在膈肌下方肝肿瘤热消融治疗中的临床应用价值。方法 重建患者上腹部CT图像，选取有代表性的3个矢状面和1个冠状面作为标准层面，在各层面建立膈下标准病灶模型，并采用足头向穿刺路径进行模拟穿刺。测量各平面上膈肌高度、穿刺路径长度及间距。采用可到达性评价模拟穿刺时穿刺针分布于标准病灶中的最理想的位置情况。结果 纳入86例患者行测量研究，多数患者矢状2、3面的膈肌高度低于2cm，仅分别对平面内1511%的病灶e和813%的病灶f进行了测量。标准病灶a、b、c、d、b’的完全到达比例分别为5243%、6097%、3837%、5294%、6353%，中位路径长度分别为1039cm、1337cm（背侧，腹侧1266cm）、1315cm、888cm、1126cm，中位穿刺路径间距分别为21cm、209cm（背侧，214cm腹侧）、206cm、211cm、2145cm。结论 采用足头向穿刺路径进行穿刺，标准病灶a、b、d、b’有较高的完全到达比例，穿刺宽容度较高，有进一步在临床中应用的价值。标准病灶c的完全到达率不高。标准病灶e、f需要采用该路径穿刺的比例不高。     

Health care access and the Americans with Disabilities Act: A mixed methods study

BackgroundThe Americans with Disabilities Act (ADA) requires that health care entities provide full and equal access to people with disabilities. However, results of previous studies have indicated that the ADA has been largely ineffective at creating systemic change in the delivery of health care.ObjectiveThe objective of this study was to examine the current barriers to health care access experienced by people with disabilities under Titles II and III of the ADA.MethodsThis study utilized a mixed methods multiphase design. In phase one, a survey and focus groups were conducted with individuals with disabilities who experienced barriers to health care access. In phase two, key informant interviews were conducted with individuals who had a role in ensuring equal access to health care for people with disabilities.ResultsIn the current context of health care reform, people with disabilities continue to experience multiple barriers to health care access under Titles II and III of the ADA. However, a notable result is that several provisions of the Patient Protection and Affordable Care Act (ACA) have likely bolstered existing directives implementing requirements for health care access under the ADA.ConclusionsThe results of this study provide additional support for a comprehensive examination of both the national standards for accessible health care and the enforcement of laws that prohibit discrimination on the basis of disability.