Examination Couch Research Articles

Measuring Spatial Radiation Dose Distribution During Abdominal Computed Tomography Scanning with Optically Stimulated Luminescence Dosimeters

PurposeAs the proportion of medical radiation exposure increases, the exposure dose has received increasing attention. When performing interventional radiological diagnosis, examiners are often exposed to radiation. Therefore, patients and medical personnel are exposed to higher amounts of radiation dose. Accordingly, we used optically stimulated luminescence dosimeters (OSLDs) to measure the ambient air kerma during abdominal CT scanning to observe the spatial distribution of the doses.MethodsAn abdominal CT scan under a voltage of 120 kVp was performed, and OSLDs were used for the measurement. The measurement range extended from the examination couch that serves as the center point to the walls and was divided into four areas. The OSLD measurements were undertaken at three different heights (i.e., 85, 140, and 150 cm from the floor) for spatial dose detection. The OSLDs were fixed up to lines at the three height levels. Each dosimetry point was 50 cm apart. In addition, the surface incident doses of the prosthesis's mammary gland, liver, and gonad were estimated.ResultsAccording to the spatial dose distribution at the three different heights, the maximum dose and minimum dose in front of the bore were 0.194 ± 0.008 and 0.006 ± 0.001 mGy, respectively; 2 m away from the bore, the dose reduced to 9% of the maximum dose. The surface incident doses of the mammary gland, liver, and gonad were 1.321 ± 0.121, 13.083 ± 0.642, and 13.441 ± 0.658 mGy, respectively.ConclusionThe spatial dose distribution revealed that the dose was the highest at the height of 140 cm and in front of the bore. The dose on the left side was higher than that on the right side. In addition, the dose was inversely proportional to the square of the distance. If the examiners must perform interventional radiological diagnosis during CT scanning, they should put on radiation protection equipment and stand behind the bore to minimize the radiation exposure.

Gradient-induced vibrations and motion-induced Lenz effects on conductive nonmagnetic orthopedic implants in MRI.

To quantify the extent of gradient-induced vibrations, and the magnitude of motion-induced displacement forces ("Lenz effect"), in conductive nonmagnetic orthopedic prostheses. The investigation is carried out through numerical simulations, for a 3 T scanner. For gradient-induced torques and vibrations, a knee and a shoulder implant are considered, at dB/dt equal to 42 T/s (rms). For motion-induced forces associated with the Lenz effect, a knee and a hip implant are studied, considering a patient who translates on the examination couch, or walks next to it. Gradient-induced torques may be within the same order of magnitude as the worst case gravitational torque defined in the ASTM standards. However, for all investigated cases, they result to be lower. In vacuum, the extent of the corresponding vibration reduces with frequency. At the lowest investigated frequency (270 Hz), it keeps below 25 μm. For an implant partially embedded in bone, the extent of the vibration increases with frequency. Nevertheless, the displacement is far lower than the worst case observed in vacuum (negligible in contact with the bone; ˜1 μm or less where the implant emerges from the bone). The Lenz effect induced by the motion of the patient through the stationary magnetic field produces forces on the order of a few millinewtons (i.e., at least two orders of magnitude lower than the implant weight). Comparing the results with mechanical loads caused by ordinary activities of daily living, and with the levels of tolerable micromotions, a good safety margin is confirmed.

Validation of a Simple Device for the Evaluation of Ankle Plantar- and Dorsi-Flexor Forces Consistent with Standard Clinical Evaluations

Measuring the forces produced at the ankle joint is critical to diagnose musculoskeletal pathologies. In standard clinical practice, ankle force is often assessed through manual joint manipulation and visual observation. This study introduces a simple apparatus, the Ankle Force Transducer (AFT), based on a uniaxial load cell capable of measuring ankle forces in conditions consistent with clinical evaluations. The AFT can be placed at the extremity of any examination couch to measure ankle forces in plantarflexion and dorsiflexion. The repeatability of the AFT was assessed in 30 healthy subjects across three sessions and in two knee postures. One patient with foot-drop condition was evaluated using the same apparatus. The intra-session coefficient of variation for plantarflexion and dorsiflexion forces was around 5% and 8%, respectively. The dominant leg exhibited greater forces than the non-dominant one, and the fully extended knee resulted in significantly larger forces with respect to the flexed knee (p < 0.001). The foot-drop patient showed a 90% reduction in dorsiflexion force in the affected limb. The AFT appears to be a user-friendly tool used to measure ankle forces, which has the potential to provide more repeatable and objective measurements of ankle forces with respect to operator-dependent evaluations.

Diagnosis and treatment of benign paroxysmal positional vertigo with manual and motorized chairs - Indication and value

Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of episodic vertigo or dizziness. While this diagnosis can be made reliably in most cases by use of targeted history taking followed by provocation maneuvers on the examination couch and subsequent repositioning maneuver, these maneuvers may not be applicable in a subgroup of patients with pre-existing conditions such as musculoskeletal or neurologic disorders. At the same time, part of patients treated on the examination couch will not respond to the repositioning maneuvers. The use of a manual or motorized turntable thus extends both the diagnostic and therapeutic options in BPPV. Thus, it enables patients with disabilities that do not tolerate classic maneuvers on the examination couch access to the required diagnostic procedures and - if needed - provides targeted treatment as well. Furthermore, turntables extend both the diagnostic and the therapeutic spectrum, offering a broader range of repositioning maneuvers in unclear or treatment-refractory cases. In this narrative review potential indications are described and evidence for using turntables in the diagnosis and treatment of BPPV on the turntable is discussed.

Clinical assessment of tibial torsion differences. Do we always need a computed tomography?

BackgroundTibial torsional malalignment presents a well-known complication of intramedullary nailing for tibial shaft fractures.PurposeObjective of this study was to investigate the ability to clinically assess tibial torsion differences. Computed Tomography (CT) was used here as the gold standard. Further, intra- and inter-observer reliability of the clinical examination, and radiological measurements were calculated.MethodsFifty-one patients with torsion-difference CTs, obtained for various reasons, were asked to kneel on an examination couch with free hanging feet. All patients are positioned with 90° flexed knee and neutral ankle. A picture of the lower extremities was obtained from the back of the patient. Two blinded orthopedic surgeons were asked to look at the pictures and measure the tibial torsion with a digital goniometer, based on the axis of the femur in relation to the second ray of the foot. To determine the intra-observer variation, the torsional angles were calculated again after 4 weeks. To be able to compare values, two blinded radiologists calculated torsional differences based on computed tomography.ResultsAll patients were able to be positioned for clinical assessment (n = 51). Clinical assessment of torsional difference revealed 4.55° ± 6.85 for the first, respectively, 4.55° ± 7.41 for the second investigator. The second measurement of the first investigator revealed a value of 4.57° ± 6.9. There was a good intra-observer agreement for clinical assessment (ICC 0.993, p < 0.001). Also, the inter-observer agreement showed a good inter-observer agreement (ICC 0.949, p < 0.001). Evaluation of radiological inter-observer assessment could also show a good inter-observer agreement (ICC 0.922, p < 0.001). The clinical method showed a good correlation to the CT method (0.839, p < 0.001). Additionally, the Bland–Altman plot was used to compare graphically both measurement techniques, which proved the agreement.ConclusionIn summary, computed tomography-assisted measurement of tibial torsion and clinical assessment correlated significantly good. In addition to that, clinical measurement has a good intra- and inter-observer reliability. Clinical examination is a reliable and cost-effective tool to detect mal-torsion and should be part of the repertoire of every surgeon.

The Relationship between Selected Body Composition Components and Cardiopulmonary Resuscitation Parameters in Nurses: An Observational Simulation Study.

The provision of cardiopulmonary resuscitation (CPR) may be related to the physical parameters of the medical personnel, including fat mass (FM) and fat-free mass (FFM) components. In this study, we aimed to assess the relationship between selected body composition components and chest compression and ventilation parameters provided by medical staff. An observational simulation study was undertaken between December 2017 and January 2019 at the Center for Innovative Research in Medical and Natural Sciences of Rzeszów. In all participants (505 nurses, 37.71 y ± 12.16), the body weight and height were measured and the body mass index (BMI) was calculated. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101. Afterwards, all participants performed CPR sequences (30 chest compressions and rescue for 2 breaths) for 2 min on a Laerdal Resusci Anne simulator placed on an examination couch with a self-inflating bag and a face mask. Our observations proved that high values of the anthropometric, nutritional and body composition parameters of the medical staff demonstrated a positive significant correlation with the depth and rate chest parameters and were inversely related to the chest adequate recoil. No statistically significant differences were found between the FM or FFM components and ventilation parameters. This study showed that nutritional status and body composition components may be important factors affecting the quality of CPR.

A case-control study of airborne dissemination of bacteria during CT colonography.

The COVID-19 pandemic has highlighted the importance of aerosol spread of infection. We have conducted a study to detect bacterial contamination of room surfaces and room air during CT colonography and confirm the efficacy of room disinfection procedures carried out between examinations. Systematic sampling of the CT examination couch and horizontal surfaces 1 m and 3 m from the couch was performed before and after patient examinations. A 1 m3 sample of room air was obtained during patient examinations. Samples were processed using routine laboratory methods. A case-control study design was used (30 CT colonography and 30 routine body CT scans). Evidence of airborne dissemination of bacteria was detected in >30% of CT colonography examinations and <10% of control examinations (p = 0.01). No pathogenic bacteria were detected in surface samples taken before patient examinations. The room disinfection policy in use in our CT department is effective in eliminating pathogenic bacteria from surfaces in the patient environment. CT colonography causes contamination of room air with enteric bacteria in a significant proportion of cases. CT colonography may possibly be an aerosol-generating procedure. Larger-scale investigation is needed to fully evaluate this potential infection risk.

Monte Carlo-based patient internal dosimetry in fluoroscopy-guided interventional procedures: A review.

This systematic review aims to understand the dose estimation approaches and their major challenges. Specifically, we focused on state-of-the-art Monte Carlo (MC) methods in fluoroscopy-guided interventional procedures. All relevant studies were identified through keyword searches in electronic databases from inception until September 2020. The searched publications were reviewed, categorised and analysed based on their respective methodology. Hundred and one publications were identified which utilised existing MC-based applications/programs or customised MC simulations. Two outstanding challenges were identified that contribute to uncertainties in the virtual simulation reconstruction. The first challenge involves the use of anatomical models to represent individuals. Currently, phantom libraries best balance the needs of clinical practicality with those of specificity. However, mismatches of anatomical variations including body size and organ shape can create significant discrepancies in dose estimations. The second challenge is that the exact positioning of the patient relative to the beam is generally unknown. Most dose prediction models assume the patient is located centrally on the examination couch, which can lead to significant errors. The continuing rise of computing power suggests a near future where MC methods become practical for routine clinical dosimetry. Dynamic, deformable phantoms help to improve patient specificity, but at present are only limited to adjustment of gross body volume. Dynamic internal organ displacement or reshaping is likely the next logical frontier. Image-based alignment is probably the most promising solution to enable this, but it must be automated to be clinically practical.

Which factors affect the ability to kneel following total knee arthroplasty? An outpatient study of 100 postoperative knee replacements.

Kneeling is an important activity of daily living, holding social, religious and occupational value. Following total knee replacement (TKR), many patients report they are unable to kneel or have been advised not to kneel. We observed 100 consecutive knee replacements in 79 patients attending outpatient clinic at a minimum 5 months post-TKR. The patients were asked to fill out a questionnaire detailing whether they were able to kneel prior to their knee replacement and whether they thought they were able to kneel since their knee replacement. The patients were then asked to kneel on a padded examination couch and then onto a pillow on the floor for 15 s. Degree of flexion achievable was also recorded. Of the knees with patella resurfacing, 78.6% were able to kneel compared to only 45.6% knees with native patellae. Two-tailed Fisher's exact test showed this difference to be statistically significant (p = 0.001). The χ2 analysis showed that those patients with an achievable flexion of angle of greater than 100° were significantly more likely to be able to kneel than those with a flexion angle of less than 100° (p = 0.0148). Comparing posterior cruciate ligament (PCL) retaining against PCL sacrificing implants, there was no statistically significant difference in kneeling ability (p = 0.541). Kneeling remains an important function in patients undergoing TKR, with patella resurfacing significantly improving the likelihood of a patient being able to kneel.

On the examination couch: the relationship between the egocentric perspective and the attentional focus

ABSTRACTDetermined by anatomical characteristics, the binocular visual field has an elliptical shape. Whereas the focus of attention – that area of the visual field in which objects can be consciously perceived – is significantly smaller, its shape is not necessarily dependent on the same factors. Indeed, it is yet unknown if the maximum extents of the attentional focus’ meridians are dimensionally stable or adapt to the egocentric perspective. In this study, we intended to measure the expansion up to which peripheral stimuli can still be perceived while participants were sitting and lying on the left and on the right body side. Results demonstrate that contrary to the visual field the maximum extents along the attentional focus’ meridians remain stable across different head positions with a greater horizontal than vertical alignment. This indicates that the expansion ratios of the meridians of the attentional focus are not dependent on the egocentric perspective. Rather, they appear stable in space and gravity-based. Findings are discussed in terms of our visual environment and current as well as alternative interpretations are weighed against each other.

Ultrasound of the infant hip: manual fixation is equivalent to Graf\u2019s technique regarding image quality\u2014a randomized trial

BackgroundIn Middle Europe ultrasonography is the standard method used to screen for developmental dysplasia of the hip in infants. Our aim was to determine whether manual fixation of the child is equivalent to Graf’s technique regarding image quality.MethodsThis randomized trial was conducted at a free-standing general pediatric outpatient clinic in Vienna, Austria. Healthy infants in the 1st and between the 6th and 8th week of life with no hip malalignment were included. After randomization, Group 1 was examined using Graf’s fixation device and participants in Group 2 were fixated on the examination couch by their parents. In a second step, all images underwent a blinded evaluation.ResultsA total of 117 babies (Group 1: n = 62, Group 2: n = 54, excluded: n = 1) were examined and 230 images (Group 1: n = 122, Group 2: n = 108) were evaluated, of which 225 were sonographically normal. Two images, showing a type IIa right hip and a type IIa + left hip respectively, were excluded. One participant had to be excluded as the respective images showed two pathologic hip joints. Two images in Group 1 and three in Group 2 were not evaluable. No statistical association between image quality (11 quality criteria and overall evaluability) and fixation technique (0.12 ≤ p ≤ 1.0 or constant) was found.ConclusionsConsidering sonographically normal hip joints, we found no evidence that manual fixation differed from Graf’s technique regarding image quality. In future studies, hip pathologies should be included and discomfort of infants and parents during the examination should be addressed.Trial registrationGerman Clinical Trials Register, ID: DRKS00015694), registered retrospectively on October 7th, 2018.

John Kenelm Guly

After house officer posts at St Mary’s and Colindale hospitals, John Kenelm Guly entered general practice in 1953. He was a trainee to Dr John Ford and later joined him...

Isolation and antibiotic susceptibility test of bacteria from healthcare workers and hospital environment

Hospital-acquired infections are one of the most significant adverse events for healthcare institutions increasing morbidity and mortality. The hospital environment is a potential source of infection especially with pathogenic bacteria. The study was aimed at identifying some possible sources of pyogenic bacterial infections in a Private hospital and determining the antibiotic susceptibility. Bacteriological analysis of swabs from hands of health care staff, the floors in the wards and clinics, beds and examination couches in the clinics and wards was carried out. Organisms were identified by Gram stain, catalase and coagulase test oxidase test.Bacillus spp and Streptococcus spp were isolated from the floor, bed and air. Staphylococcus spp was isolated from the hands of health workers. The organisms isolated were resistant to cloxacillin, amoxicillin, and streptomycin but susceptible to ofloxacin, gentamicin and co-trimoxazole. The findings in this study reveal that the hospital environment and the hands of healthcare workers can serve as a reservoir for antibiotic resistant microorganisms.

Adequacy of Work Environments in Public Dispensaries and Health Centers in Machakos County, Kenya

The Occupational Safety and Health Act (OSHA) mandates employers to uphold the highest standards of occupational safety and health in their workplaces. However, occupational incidents persist in public health facilities. The researcher sought to assess the adequacy of work environments in public dispensaries and health centers in Machakos County. The study was a cross-sectional survey conducted in February, 2018 involving fourteen (14) dispensaries and seven (7) health centers. Researchers took linear dimensions and angles in the facilities. Assessment involved measuring workrooms, doors, windows, and passageways; computing areas and air volumes; and observing patient examination couches and material storage. The researcher recorded data in checklists then tabulated and analyzed for adequacy.79% of the workrooms ceiling heights were less than the required 3m. 52.5% of the workrooms had less air volumes per worker than the specified 10m³. 61.5% of the rooms did not have <i>through</i> ventilation. All the 27 patient examination couches had no height adjusters. 77.8% of material storage shelves had no equipment to reach heights. 51.3% of doors were less than 900mm wide. 57.1% of passageways were less than 1.2 meters wide. 61.9% of the passageways were obstructed. Work environments within the selected facilities were inadequate. OSHA should be reviewed to provide standards for various elements. Directorate of safety and health services should help health facilities to improve adequacy of work environments. Health management should make all aspects of work environments adequate.

Qualitative Research and Clinical Methods

&lt;div class="WordSection1"&gt;&lt;p&gt;I am honored for being an alumnus of KEMC, and am delighted to write this editorial for the Annals. I have, ever since done my research and taught qualitative methods, felt that clinical methods are quite akin to qualitative research. Then, why only few clinical researchers use qualitative methods? A witness to this assumption is the research published in the Annals. In this treatise, I try to identify some parallels between the two types of methods and argue for the clinicians to invest in learning qualitative research methods to practice clinical methods well.&lt;/p&gt;&lt;p&gt; Qualitative research is to identify and interpret issues from the perspective of participants, their experience of: illness or disability, using health service, and to appreciate the meanings they give to the behaviour, events or objects in the context of their social and cultural norms. In this type of research, the emphasis is on exploring the associations and understanding the phenomenon in its holism; and not, like in quantitative research, from an outsider’s perspective and for certain specific aspects.&lt;sup&gt;1&lt;/sup&gt; It requires participants with specific characteristics, selected purposely that can best inform the research topic. More participants, identified inductively during data collection, are added to develop full and multiple perspectives about the cases.&lt;sup&gt;2&lt;/sup&gt;&lt;/p&gt;&lt;p&gt; No preset data collection tool is used, instead qualitative researcher guided by a research question acts as an instrument, since the line of enquiry he changes during data collection as new understanding is gained and/or the situation changes.&lt;sup&gt;3&lt;/sup&gt; The data for research is derived from the observation, interviews or verbal interactions, focus group discussions, document reviews, life histories etc. and the researcher asks why, how and under what circumstances things occur; and not just what, where and when. It is recorded in words or pictures and log book is used to record notes arising from interviews, observations, extracts from documents etc.&lt;/p&gt;&lt;p&gt; In health care settings patients are the subjects for clinical methods. The clinician, even prior to any verbal communication, observes the patient, e.g. for his gait and appearance. If in a bed or examination couch, his posture could give some clue to the illness. Inspection, a clinical method, is like systematic observation, which is qualitative method, should be holistic. In my third year during bedside teaching, Professor (late) Rashid Ahmed Qureshi said, &lt;em&gt;“patient has come to you as a whole and not his stomach in a tray”&lt;/em&gt;, when a student straight went to examine abdomen of a patient with acute abdomen. History taking, another clinical method, is like conducting semi structured in depth interview – a qualitative research method. In both disciplines, we are told, &lt;em&gt;“not to ask leading, but follow up and probing questions”; &lt;/em&gt;and Professor (late) Alamgir Khan, while teaching clinical methods, would add, &lt;em&gt;“if a good history is taken, you will establish diagnosis in over 65% of cases”. &lt;/em&gt;Likewise, as part of history taking, documents related to patient’s illness history and treatment are reviewed similar to document review in qualitative research.&lt;/p&gt;&lt;p&gt; The two approaches however differ in how the data is analysed. In clinical practice, diagnosis is established based on the pathophysiological knowledge or patient’s clinical condition is discussed in clinicopathological conference.&lt;sup&gt;4&lt;/sup&gt; On the other hand, qualitative research employs meaning based data analysis, whereby the qualitative data is transformed into some form of explanation, understanding or interpretation of people and situation that is investigated.&lt;sup&gt;5,6&lt;/sup&gt;&lt;/p&gt;&lt;p&gt; In conclusion, the history, the observation and the review of document related to patient are since obtainned using qualitative methods, the clinician trained in these methods could not only conduct these methods well but also interpret the data to identify and detect obstacles to the change in clinical condition and the reasons why improvement does or does not occur.&lt;sup&gt;7&lt;/sup&gt; Finally, while it is heartening that research forums are organised in the institutions affiliated with KEMU, in order the research is richer, the researchers’ skills in qualitative research methods should be built.&lt;/p&gt;&lt;/div&gt;

VirtoScan - a mobile, low-cost photogrammetry setup for fast post-mortem 3D full-body documentations in x-ray computed tomography and autopsy suites.

Injuries such as bite marks or boot prints can leave distinct patterns on the body's surface and can be used for 3D reconstructions. Although various systems for 3D surface imaging have been introduced in the forensic field, most techniques are both cost-intensive and time-consuming. In this article, we present the VirtoScan, a mobile, multi-camera rig based on close-range photogrammetry. The system can be integrated into automated PMCT scanning procedures or used manually together with lifting carts, autopsy tables and examination couch. The VirtoScan is based on a moveable frame that carries 7 digital single-lens reflex cameras. A remote control is attached to each camera and allows the simultaneous triggering of the shutter release of all cameras. Data acquisition in combination with the PMCT scanning procedures took 3:34min for the 3D surface documentation of one side of the body compared to 20:20min of acquisition time when using our in-house standard. A surface model comparison between the high resolution output from our in-house standard and a high resolution model from the multi-camera rig showed a mean surface deviation of 0.36mm for the whole body scan and 0.13mm for a second comparison of a detailed section of the scan. The use of the multi-camera rig reduces the acquisition time for whole-body surface documentations in medico-legal examinations and provides a low-cost 3D surface scanning alternative for forensic investigations.

Test in peace.

As usual, I finished with a cartoon. It pictured a patient sitting on the examination couch with a spear through his head and the white-coated doctor saying ‘I’m pretty sure I know what the problem is, but just to be sure I’m ordering a battery of tests. ’ It had been a provocative session. I had presented on the exponential increase in test ordering over recent decades, and the consequent costs (real and opportunity) to health systems around the world.1 We had discussed the challenges of managing ‘incidentalomas’, illustrated by a recent patient I had looked after with an angiomyolipoma of the kidney identified as a result of a request for a scrotal ultrasound. No word of a lie. And we debated the very real …

Pneumothorax Complication of Deep Dry Needling Demonstration

Pneumothorax is a well-recognised but rare adverse event related to acupuncture or deep dry needling (DDN) over the thorax.1 ,2 This report of a pneumothorax resulting from DDN is unusual for a number of reasons: both the practitioner and the subject were doctors and both have contributed to this report; the practitioner was very experienced in DDN and had not knowingly caused such an event in the previous 45 years of practice and teaching DDN; the incident was captured on video and is presented online with this report (see online supplementary video). We hope that by reporting this event and review of the video recording we can suggest ways to reduce the risk of reoccurrence of such adverse events of DDN. The setting was a hands-on workshop teaching the technique of DDN for the treatment of myofascial pain syndromes. The workshop used the format of lecture, demonstration on a volunteer, and then practice by the group in groups of two or three individuals at an examination couch. Safety procedures were emphasised for each muscle considered. The safety precautions included identification of landmarks each time one prepared to needle the subject and an awareness of the local anatomy and of possible complications. During the introduction to the demonstrations the complication of pneumothorax was discussed. Symptoms were described and the advice to go to the emergency department for a chest X-ray was given. The muscle to be demonstrated was the iliocostalis muscle, one of the erector spinae muscles. RR-M volunteered to be the subject. The lecturer emphasised the danger of pneumothorax and spoke of the technique of ‘blocking’ the rib by placing a finger …

A Seated Single-Person Dial-Test for Posterolateral Corner and Posterior Cruciate Ligament Knee Injuries

Background: Injuries to the posterolateral corner of the knee (PLC) can be difficult to diagnose and are often missed. The prone dial test can be difficult to perform in the acute setting and the supine dial test requires an assistant. Purpose: We present a simple single person seated dial test that can easily be performed in all patients with a suspected diagnosis of PLC injury. Study Design: Case Series. Method: The patient is seated on the edge of the examination couch with their knees flexed over the side and their calves pressed against the couch to reduce any posterior tibial subluxation. The patients’ knees are placed together ensuring the pelvis is square; the knees are at the same level, and the patellae are facing anteriorly. The patients place their hands against the side of their knees and hold their knees together in this position. The examiner then grasps the patient’s feet, approximates the medial malleoli and exerts a lateral rotational force at 30 and 90 degrees of knee flexion. Results: This test has 100% accuracy for diagnosing PLC injury in our institution. Conclusion: We present a sample to use alternative to traditional dial testing that does not require an assistant and also does not require the patient to be prone, thus limiting discomfort in the acute setting.

Optimising standards of safety & quality in clinical care environment for maternal obesity through assessing availability of bariatric equipment

BackgroundObesity related hospital admissions increased 700% in last decade. Assessment of availability of suitable bariatric equipment across clinical areas is essential to optimise care environment for this vulnerable group to...