The effects of clinical support surfaces on pressure as a risk factor in the development of pressure ulcers, from a radiographical perspective: a narrative literature review

Purpose: Pressure ulcers are a high cost, high volume issue for health and medical care providers, having a detrimental effect on patients and relatives. Pressure ulcer prevention is widely covered in the literature, but little has been published regarding the risk to patients in the radiographical setting. This review of the current literature is to identify findings relevant to radiographical context. Methods: Literature searching was performed using Science Direct and Medline databases. The search was limited to articles published in the last ten years to remain current and excluded studies containing participants less than 17 years of age. In total 14 studies were acquired; three were excluded as they were not relevant. The remaining 11 studies were compared and reviewed. Discussion: Eight of the studies used ‘healthy’ participants and three used symptomatic participants. Nine studies explored interface pressure with a range of pressure mat technologies, two studies measured shear (MRI finite element modelling, and a non-invasive instrument), and one looked at blood flow and haemoglobin oxygenation. A range of surfaces were considered from trauma, nursing and surgical backgrounds for their ability to reduce pressure including standard mattresses, high specification mattresses, rigid and soft layer spine boards, various overlays (gel, air filled, foam). Conclusion: The current literature is not appropriate for the radiographic patient and cannot be extrapolated to a radiologic context. Sufficient evidence is presented in this review to support the need for further work specific to radiography in order to minimise the development of PU in at risk patients.

Niedokladna mapa teatralna portugallii

ABSTRACT - This text is divided in two parts. Firstly, I deal with the evolution on Portuguese theatre from the post-second world war period until present day. I’m focusing on the experimentalism of the forties, characterized by an urge for renewal and modernization; the constitution of a highly politicized independent theatre movement, in the seventies; and the plurality of contemporary Portuguese theatre. Secondly, I deal with the alleged inability of Portuguese writers for playwriting, signalling the most significant names of the post Carnation Revolution, on the 25th of April 1974, to present days.

Qualified intervention/qualifying formation

An education promoting scientific literacy (SL) that prepares the citizens to a responsible citizenship has persisted as an argument across discussions on curricula design. The ubiquity of science and technology on contemporary societies and the ideological requirement of informed democratic participation led to the identification of relevant categories that drive curriculum reforms towards a humanistic approach of school science. The category ‘Science as culture’ acquires in the current work a major importance: it enlightens the meaning of scientific literacy. Looking closely to the French term, culture scientifique et tecnologique, turns science simultaneously into a cultural object and product that can be both received and worked at different levels and within several approaches by the individuals and the communities. On the other hand, nonformal and informal education spaces gain greater importance. Together with the formal school environment these spaces allow for an enrichment and diversification of learning experiences. Examples of nonformal spaces where animators can develop their work may be science museums or botanical gardens; television and internet can be regarded as informal education spaces. Due to the above mentioned impossibility of setting apart the individual or community-based experiences from Science and Technology (S&T), the work in nonformal and informal spaces sets an additional challenge to the preparation of socio-cultural animators. Socio-scientific issues take, at times, heavily relevance within the communities. Pollution, high tension lines, spreading of diseases, food contamination or natural resources conservation are among the socio-scientific issues that often call upon arguments and emotions. In the context of qualifying programmes on socio-cultural animation (social education and community development) within European Higher Education Area (EHEA) the present study describes the Portuguese framework. The comparison of programmes within Portugal aims to contribute to the discussion on the curriculum design for a socio-cultural animator degree (1st cycle of Bologna process). In particular, this study intends to assess how the formation given complies with enabling animators to work, within multiple scenarios, with communities in situations of socio-scientific relevance. A set of themes, issues and both current and potential fields of action, not described or insufficiently described in literature, is identified and analysed in the perspective of a qualified intervention of animators. One of these examples is thoroughly discussed. Finally, suggestions are made about curriculum reforms in order, if possible, to strongly link the desired qualified intervention with a qualifying formation.

An evaluation of SAFIRE’s potential to reduce the dose received by paediatric patients undergoing CT: a narrative review

Introduction: The purpose of this review is to gather and analyse current research publications to evaluate Sinogram-Affirmed Iterative Reconstruction (SAFIRE). The aim of this review is to investigate whether this algorithm is capable of reducing the dose delivered during CT imaging while maintaining image quality. Recent research shows that children have a greater risk per unit dose due to increased radiosensitivity and longer life expectancies, which means it is particularly important to reduce the radiation dose received by children. Discussion: Recent publications suggest that SAFIRE is capable of reducing image noise in CT images, thereby enabling the potential to reduce dose. Some publications suggest a decrease in dose, by up to 64% compared to filtered back projection, can be accomplished without a change in image quality. However, literature suggests that using a higher SAFIRE strength may alter the image texture, creating an overly ‘smoothed’ image that lacks contrast. Some literature reports SAFIRE gives decreased low contrast detectability as well as spatial resolution. Publications tend to agree that SAFIRE strength three is optimal for an acceptable level of visual image quality, but more research is required. The importance of creating a balance between dose reduction and image quality is stressed. In this literature review most of the publications were completed using adults or phantoms, and a distinct lack of literature for paediatric patients is noted. Conclusion: It is necessary to find an optimal way to balance dose reduction and image quality. More research relating to SAFIRE and paediatric patients is required to fully investigate dose reduction potential in this population, for a range of different SAFIRE strengths.

The impact of Sinogram-Affirmed Iterative Reconstruction on patient dose and image quality compared to filtered back projection: a narrative review

Objective: Summarize all relevant findings in published literature regarding the potential dose reduction related to image quality using Sinogram-Affirmed Iterative Reconstruction (SAFIRE) compared to Filtered Back Projection (FBP). Background: Computed Tomography (CT) is one of the most used radiographic modalities in clinical practice providing high spatial and contrast resolution. However it also delivers a relatively high radiation dose to the patient. Reconstructing raw-data using Iterative Reconstruction (IR) algorithms has the potential to iteratively reduce image noise while maintaining or improving image quality of low dose standard FBP reconstructions. Nevertheless, long reconstruction times made IR unpractical for clinical use until recently. Siemens Medical developed a new IR algorithm called SAFIRE, which uses up to 5 different strength levels, and poses an alternative to the conventional IR with a significant reconstruction time reduction. Methods: MEDLINE, ScienceDirect and CINAHL databases were used for gathering literature. Eleven articles were included in this review (from 2012 to July 2014). Discussion: This narrative review summarizes the results of eleven articles (using studies on both patients and phantoms) and describes SAFIRE strengths for noise reduction in low dose acquisitions while providing acceptable image quality. Conclusion: Even though the results differ slightly, the literature gathered for this review suggests that the dose in current CT protocols can be reduced at least 50% while maintaining or improving image quality. There is however a lack of literature concerning paediatric population (with increased radiation sensitivity). Further studies should also assess the impact of SAFIRE on diagnostic accuracy.

A narrative review on the reduction of effective dose to a paediatric patient by using different combinations of kVp, mAs and additional filtration whilst maintaining image quality

This paper reviews the literature for lowering of dose to paediatric patients through use of exposure factors and additional filtration. Dose reference levels set by The International Commission on Radiological Protection (ICRP) will be considered. Guidance was put in place in 1996 requires updating to come into line with modern imaging equipment. There is a wide range of literature that specifies that grids should not be used on paediatric patients. Although much of the literature advocates additional filtration, contrasting views on the relative benefits of using aluminium or copper filtration, and their effects on dose reduction and image quality can vary. Changing kVp and mAs has an effect on the dose to the patient and image quality. Collimation protects adjacent structures whilst reducing scattered radiation.