Use Of Medical Equipment Research Articles

Prediction and Diagnosis of Down Syndrome Disease by using the CHAID Algorithm

Today, development of technology and the use of modern medical equipment and update technology produce massive amounts of stored information in the medical database. Analysis and discovery of knowledge from medical database is difficult due to the high volume of data and is requires a newer technology that data mining technologies to achieve this important to help its powerful algorithms. Data mining techniques with extract knowledge and the unseen patterns from huge volumes of data and build models related to medical databases, designed decision support system that help decision-making to Medical. The main objective of this paper has been to examine how to apply data mining techniques to predict and diagnosis of Down syndrome disease based on the medical information of 200 patients referred to medical laboratories in the country by using data mining algorithm CHAID in Rapid Miner software. The results showed that the CHAID algorithm with 100% accuracy has ability diagnosis of Down syndrome disease.

Identifying Medical Equipment Usability Issues from Social Media Reports

Traditional methods of investigating usability include usability tests, heuristic evaluations, surveys, and field methods. User self-reports of equipment problems such as through the FDA MAUDE database are also available, but there may be limited information reported. Often, people turn to social media to share stories and learn from others. In this study, the authors explored using social media as a means of identifying possible usability issues with medical devices and products. As a proof of concept, the authors focused on insulin pumps, continuous glucose monitors, and sleep apnea machines. Reports of medical equipment use issues were grouped into three categories: 1) correct instructions for product use, 2) apparently inadvertent incorrect instructions for use and 3) instructions that encouraged or could promote deliberate misuse. Each of these has different implications for designers, clinical product review committee members, and clinicians.

Assistant computer program for adequate disposal of medical devices

In developing countries, up to 80% of medical equipment comes from donation. The World Health Organization (WHO) has made recommendations on desirable factors that should be taken into consideration when donating medical technology. We included these recommendations while building the Assistant Program for Adequate Disposal of Medical Devices (APAD) using the application generator App Building by MATLAB. We evaluated thirty units of medical equipment from different areas of a secondary health care level hospital. The Instrumentation Technician (IT) (expert) previously defined if the medical units were suitable to be donated, could be repaired, could be used as reservoir, or should be completely removed. APAD also made a proposal of the possible use of this technology. In 23 out of 30 medical units, the decision made by the APAD matched with that of the expert: seven for donation, eight to be repaired, two to serve as reservoir and six for disposal. Our results suggest that APAD could serve as a support tool for the IT and for the Biomedical Engineering Department in a hospital, to determine the possible use of medical equipment that has been discarded.

THE TRUE ROLE OF STETHOSCOPE - CLINICAL PARADIGM

Technologies have "taken over" medical practice and through them the diagnostic process has become faster, more accurate, early and secure, and treatment is effective and encouraging. The positive results are indisputable, but at the same time, the old prophecy was doomed to oblivion. As a consequence, less clinical thinking and less skill in a non - standard environment (field conditions).The article presents the real role of a medical stethoscope in medical practice. A clinical case of asymptomatic spontaneous pneumothorax in interstitial pneumonia due to a complication of rupture of the vein, diagnosed with a medical stethoscope only, has been considered.The analysis of the physical findings is important. A key point in the analysis is the mismatch between the "expected" change in the clinical and physical picture and the "reported" physical finding, which is the evolution of the pulmonary parenchymal syndrome - instead of pure vesicular breathing, to the syndrome - air in the pleural cavity .Theoretically, a clinical paradigm of clinical thinking, containing the components, has been developed and practically applied to the clinical case: a description of the specificities of each symptom, two aspects of a working diagnosis - what and what is not; a logical connection between the symptoms, an analysis of small deviations and nuances - a pathway to accurate diagnosis and associative thinking.Through the stethoscope in combination with medical knowledge and clinical associative thinking, human life can be saved.The current trend is to replace the stethoscope by automated versions. As a traditional method it will not disappear altogether because it is the cheapest and does not require electricity, which makes it a good backup method in developed regions and a logical first choice in some developing regions. The routine use of modern medical equipment allows the examination of medical problems in depth, but not in large scale in association with other symptoms as a process, and the discovery of the causes of the problem. The solution is in the possibility of old physical methods, in combination with associative clinical thinking.The real role of the medical stethoscope returns to the classics of medical science and healing as it is known in its historical nature - such as soul, vocation, and dedication. The medical stethoscope gives the physician the freedom to be a doctor - to himself, anywhere in the world, under all circumstances and under harsh conditions.

Normativa vigente en España sobre la utilización de la diatermia en medicina y ciencias del deporte

Introducción: En el tratamiento de las lesiones deportivas se utilizan diferentes formas de energía electromagnética, entre ellas la diatermia, con fines terapéuticos. El uso seguro de los dispositivos de diatermia, tanto para el paciente como para el personal sanitario que los aplica, se basa en estándares profesionales, códigos de seguridad y directrices varias, que determinan los procedimientos de uso seguros. Estas recomendaciones se encuentran dispersas y no son bien conocidas por los usuarios, por lo que fue el objetivo de esta revisión el sintetizar y actualizar dichas recomendaciones.
 Metodología: revisión de la normativa vigente en España, sobre el uso de los equipos médicos de Diatermia.
 Discusión: Esta falta de claridad en algunos fabricantes hace que se cuestione la usabilidad o aplicación de los productos que se fabrican para uso sanitario. Esta situación favorece un marketing engañoso y el cliente final queda no solo a merced de una adquisición de un equipo sin la certificación médica adecuada, sino además desprotegido legalmente en su aplicación, lo que puede traer como consecuencia sanciones legales.

Association of Changes in Anticitrullinated Protein Antibody Levels With Resource Use and Disease Activity Measures in Rheumatoid Arthritis Patients a US Observational Cohort

PurposeAnticitrullinated protein antibody (ACPA) concentration, beyond ACPA positivity, is indicative of more aggressive radiographic progression in patients with rheumatoid arthritis (RA). However, there is limited information on the association of changes in ACPA with resource use measures and/or disease activity measures. We evaluate associations between changes in levels of ACPA and outcomes, including durable medical equipment (DME) use, hospitalizations, and disease activity, in patients with established RA. MethodsPatients from the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study who had ACPA measurements at baseline and month 12 were included. Changes in ACPA levels from baseline to month 12 were categorized as a decrease (<−10%), no change (−10% to +10%), or increase (>+10%). DME use and hospitalizations were assessed twice yearly using patient questionnaires; disease activity was assessed annually. Binary multivariate logistic regression was used to analyze the association between changes in ACPA levels and DME use and hospitalizations; linear regression was used to assess the association with disease activity. FindingsOf 840 patients included in the analysis, 291 (34.6%), 266 (31.7%), and 283 (33.7%) had a decrease, no change, or increase in ACPA levels, respectively. A decrease in ACPA levels was associated with a reduction in DME use (adjusted odds ratio [aOR] = 0.64; 95% CI, 0.44–0.93; P = 0.02) and hospitalizations (aOR = 0.62; 95% CI, 0.41–0.95; P = 0.03) versus no change or increase. Adjusted mean changes in disease activity score in 28 joints (C-reactive protein), total and swollen joint counts, and pain scores were significantly greater in patients with decreased ACPA levels versus those with no change or increase (P < 0.05). ImplicationsAmong patients with RA, reductions in ACPA levels of >10% were associated with reductions in DME use, hospitalizations, and disease activity. ClinicalTrials.gov identifier: NCT01793103.

Muddling through cybersecurity: Insights from the U.S. healthcare industry

The U.S. healthcare sector is inadequately prepared to deal with the reality of cyber threats. The increasing use of smart medical equipment and mobile devices is making healthcare organizations more susceptible to ransomware and other types of malware. The size and complexity of operations, coupled with the presence of numerous legacy and incompatible systems, make it difficult to implement effective cybersecurity measures. The daunting nature of the problem often results in an if-it-ain’t-broke-don’t-fix-it stance among senior healthcare leaders. The preponderance of healthcare-related laws, compliance regulations, and security guidance frameworks serve to complicate the cybersecurity challenge further and too often results in senior leadership assuming a state of blissful ignorance. This study sheds light on the key factors contributing to the chaotic state of affairs and presents a roadmap to a more deliberate and proactive approach to cybersecurity risk management.

Satisfaction with the performance of emergency medical services: a case study in Tabriz

Objective: Assessing patients’ satisfaction with emergency medical services (EMSs) is an important managerial point of view. The present study aimed to assess the patients’ satisfaction with EMS in Tabriz, Iran. Methods: This is a descriptive-analytic study that was done in the prehospital emergency and disaster management center of Tabriz University of Medical Sciences. In this study, from May to December 2017, we included 659 patients who were transferred to hospitals with our prehospital emergency services. A valid and reliable questionnaire was used to evaluate the satisfaction of patients about the performance of prehospital EMSs. Results: Data of 659 patients were evaluated. Trauma was the most common cause of contact with 115 and help request (33.83%). The results indicated that patients’ level of satisfaction was good and very good. The highest level of satisfaction was related to the treatment of patients and use of medical equipment in the ambulance (n=578 patients, 87.7%) as well as the treatment practiced by the emergency medical technicians (EMTs) (n=575 patients, 87.24%). However, the lowest level of satisfaction was related to the absence of an active EMT in the rear cabin when transferring patients to the hospital (n=337 patients, 51.14%) and transfer of the patient from the accident scene to the ambulance (n=410 patients, 62.21%). Conclusion: Patients’ satisfaction with EMS was optimal. The minimum and maximum satisfaction rates were related to the absence of an active EMT in the rear cabin, treatment of the patient, and use of medical equipment.

Cost Analysis on Intensive Care Unit Costs Based on the Length of Stay.

The present study aimed to determine the profit/loss ratio and the service costs in intensive care unit (ICU) based on the length of ICU stay. This retrospective study reviewed the medical records of 458 patients who were admitted to ICU between August 2016 and August 2017. Depending on the length of their ICU stay, the patients were divided into six groups: (I) 1 day, (II) 2 days, (III) 3 days, (IV) 4 days, (V) 5 days and (VI) more than 5 days. These charges were evaluated under six categories: surgery, laboratory tests, drugs, tools and equipment, radiographic workup and others. This study reviewed the medical records of patients including 273 (59.6%) men and 185 (40.4%) women. The mean age of the patients was 53.87±22.6 years. The profit/loss ratio was in favour of loss in group I (12,870.82 TL), group II (9,384.61 TL) and group III (371.18 TL). The ration was in favour of profit in group IV (16,505.4 TL). Total service costs comprised 38.51% drug costs, 24.45% tools/equipment, 13.14% laboratory tests, 10% other costs, 4.92% surgical costs and 3.1% radiographic tests. The cost analysis based on the service costs in ICU with regards to the length of ICU stay revealed that due to the greater use of diagnostic, surgical and medical tools and equipment and laboratory and radiographic tests, the profit/loss ratio was in favour of loss within the first three days in ICU. This ratio turned to profit beginning from day 4 in ICU due to the decrease in the use of these equipment and tests. Moreover, total ICU costs comprised 38.51% drug costs and 24.45% medical tools and equipment.

Abstract 161: Adding Social and Functional Determinants of Health Improves Readmission Risk Prediction in Urban Underserved Adults Hospitalized for Acute Myocardial Infarction

Background: Although social and functional determinants of health (SFDoH) are increasingly recognized to contribute to increased 30-day readmission risk for cardiovascular illnesses, most health systems lack individual-level data to enable individual risk stratification and targeted interventions to address these needs. We sought to determine whether electronic health record (EHR) data in SFDoH domains collected as a part of routine inpatient care from a safety-net hospital could be used to enhance prediction of 30-day readmissions beyond traditional clinical risk factors alone among underserved adults hospitalized with acute myocardial infarction (AMI). Methods: We used Epic EHR data on AMI hospitalizations from 2014-2017 in an urban safety-net hospital in Dallas to predict non-elective 30-day readmissions to any of 75 hospitals in north Texas, using a regional all-payer hospitalization database. We started with the AMI READMITS score, our previously validated model consisting of 7 clinical risk factors. Next, we derived and validated an enhanced model incorporating SFDoH predictors. EHR data for candidate SFDoH predictors included structured, semi-structured, and short free-text fields from demographics, encounter types, note types, and case manager, social worker, and nursing inpatient flowsheets. We selected novel predictors using stepwise backward selection with a threshold of p≤0.20, forcing in the composite AMI READMITS score. We conducted sensitivity analyses using forward selection, lasso regression, and random forest which resulted in similar models. We internally validated our final model using 5-fold cross-validation and compared model performance to the AMI READMITS score. Results: Of 1,071 hospitalizations, 154 (14.5%) were readmitted within 30 days. In addition to the composite AMI READMITS score, our final model included 9 SFDoH risk factors, including neighborhood poverty (aOR 1.39, 95% CI 0.91-2.14), address change in the past year (aOR 1.53, 95% CI 0.96-2.46), any opioid use in the past year (aOR 2.35, 95% CI 1.36-4.05), history of durable medical equipment use in the past year (aOR 1.70, 95% CI 1.02-2.82), and ADL impairments in feeding, bathing, and toileting in the past year (aOR 1.81 for all three impairments, 95% CI 0.99-3.29). The AMI READMITS+SFDoH model had better discrimination than AMI READMITS alone (optimism-corrected C-statistic 0.69 vs 0.62, p&lt;0.001), was able to predict a broader range of probabilities for readmission risk (3.6-72.7% vs. 8.2-37.2%), and improved net reclassification (categorical NRI of highest 2 risk quintiles vs. lowest 3 of 0.09, 95% CI 0.00-0.18). Conclusions: Incorporating existing EHR data on social and functional determinants of health improved readmission risk prediction after an AMI hospitalization in an urban underserved population.

Informative censoring by health plan disenrollment among commercially insured adults

Health plan disenrollment occurs frequently in commercial insurance claims databases. If individuals who disenroll are different from those who remain enrolled, informative censoring may bias descriptive statistics as well as estimates of causal effect. We explored whether patterns of disenrollment varied by patient or health plan characteristics. In a large cohort of commercially insured adults (2007-2013), we examined two primary outcomes: (a) within-year disenrollment between January 1 and December 30, which was considered to occur due to patient disenrollment from the health plan, and (b) end-of-year disenrollment on December 31, which was considered to occur due to either patient disenrollment from the health plan or withdrawal of the entire health plan from the commercial insurance database. In yearly cohorts, we identified factors independently associated with disenrollment by using log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI). Among 2053100 unique patient years, the annual proportion of within-year disenrollment remained steady across years (range, 13% to 14%) whereas the annual proportion of end-of-year disenrollment varied widely (range, 8% to 26%). Independent predictors of within-year disenrollment were related to health status, including age, comorbidities, frailty, hospitalization, emergency room visits, use of durable medical equipment, use of preventive care, and use of prescription medications. In contrast, independent predictors of end-of-year disenrollment were related to health plan characteristics including insurance plan type and geographic characteristics. Differential risk of disenrollment suggests that analytic approaches to address selection bias should be considered in studies using commercial insurance databases.

Investigation of the actual conditions of users of a home-visiting bathing service based on the long-term care insurance care ranking and factors affecting the judgment of bathing possibility

In home-visiting bathing services (HVBs), a nurse's role is to evaluate the vital signs, judge bathing possibilities and provide treatment before/after bathing. There are no guidelines regarding specific physical criteria for judging the bathing possibility. However, the body condition of HVB users during bathing has not been investigated. Thus, the present study aimed to clarify users' actual conditions and the factors related to the judgment of the possibility of bathing. An anonymous self-administered questionnaire survey of HVBs users was conducted by Company-A, which provides HVBs. Six hundred sixty responses were collected (response rate: 40.1%).We described the conditions of HVB users and used chi-squared tests and logistic regression analyses to confirm the factors, including the certified Long-term Care Insurance (LTCI) care rank, past medical history and physical conditions that were associated with aborted HVB experiences. The mean age of the care-recipients was 82.1±12.1 and 93.3% of the recipients had severe conditions, including conditions necessitation the use of medical equipment, pressure ulcers, and contracture. The logistic regression analysis showed that the LTCI-certified-care-rank, the presence of pain, and the need for treatment before bathing were significant factors. This study showed that users of HVBs not only had high LTCI-certified-care ranks, but that they also required pain management and pre-bathing treatment.

An Investigation On Current Green Design Practices Towards Net-Zero Energy Buildings (NZEBs) Application In Malaysia Healthcare Projects

These days, the topic on the sustainable building has become one of the most important concerns in the academic studies, construction industries, as well as governmental agencies. Sustainability in the building sector has raised the attention towards a new concept called net-zero energy buildings (NZEBs). With regards to the development of Malaysia’s buildings sectors, the government has realised the undesirable effects of inefficient of energy usage by demonstrating their efforts in Construction Industry Transformation Programme (CITP) 2016-2020. Commonly, healthcare buildings are among the greatest energy consumers of any institution and the extensive use of various medical equipment, mechanical ventilation of this building has caused a high level of carbon emission. Hence, by concentrating on these issues, NZEBs become an important concept to be implemented in healthcare buildings. However, the awareness of NZEBs in Malaysia is still low and the construction industry in Malaysia still unaware of NZEBs. This paper aims to investigate the current design practices of healthcare buildings in Malaysia as well as the architect’s understanding of NZEBs through preliminary investigation among architects. Literature was reviewed and pilot studies by using semi-structured interviews were conducted. The results uncover that some green practices related to the design practices in healthcare buildings has been carried out and some of these practices are similar to the NZEBs design practices even though the term of ‘NZEBs’ is not being used. It is predicted that the paper will provide a basic knowledge for future research in NZEBs for healthcare buildings, challenges of NZEBs implementation and designing NZEBs for healthcare buildings in Malaysia.Keywords: Net zero energy buildings, Healthcare building, Current green design practices, Malaysia

Recommendations for the standards of equipping of the Bariatric and Metabolic Surgery Center.

The prevalence of obesity in Poland and worldwide is constantly rising. High effectiveness of bariatric surgery has been proven in literature. It is recommended that bariatric procedures should be done by highly qualified surgeons with the appropriate, up-to-date medical equipment. The purpose of the study is to establish Polish recommendations and standards for the use of medical equipment for bariatric surgery centers. The review of the present recommendations of the worldwide organizations and societies (including EAES, IFSO, SAGES) and guidelines was made. On the basis of current literature and authors&apos;s clinical experience we proposed standardized protocol for bariatric surgical equipment. Relevant equipping of bariatric surgery centers and implementation of standardized perioperative and surgery protocols will result in significant improvements in bariatric treatment. This will ensure patients safety, a shorter length of hospital stay and considerably reduce the risk of morbidity. Moreover, it will contribute to the efficacy of the bariatric and metabolic surgery procedures, in accordance with the highest globally accepted standards.

TACTICAL MEDICINE INSPIRING CIVILIAN RESCUE MEDICINE IN THE MANAGEMENT OF HAEMORRHAGE

Accidents remain to be the most common cause of death amongst men of ages 10–39 and women of ages 5–24. The sudden occurrence of simultaneous multiple events or a mass casualty event with many patients suffering severe injuries, including severe haemorrhage, requires emergency medical personnel to modify the algorithms, which dictate their actions. The military war mission in Iraq and Afghanistan brought many experiences, which were used and applied to guidelines, which are now used for the management of patients experiencing trauma in the civilian sector. The current trauma ITLS (International Trauma Life Support) guidelines suggest to use compression bands or haemostatic dressings in order to control bleeding in case of massive haemorrhage. An example of this recommendation being used can be seen in the regional par­amedic station in Poznan, Poland, where each ambulance is outfitted with “rescue packages” to be used in the event of massive haemorrhage. This practice can also be seen in Great Britain as well as Germany, where local protocols recommend the use of medical equipment taken from tactical medicine. The use of such tools allows for achieving a greater chance of rapid and effective haemostatic control in the event of massive haemorrhaging. These tools allow for more efficient use of time at the scene of the event, reducing the time a patient spends at the scene, allowing more rapid transport to hospital and more specialised surgical support. Reducing the time spent at the scene of an event while carrying out important procedures such as stabilising the patient’s airway, stopping haemorrhage and immobilising the patient, markedly improves the survival of trauma patients.

PP156 Risk Assessment Of Equipment Used In Intensive Care Units

Introduction:Knowledge and proper use of hospital equipment are essential for preventing adverse events associated with their use. The risks controls for medical devices and equipment are of major importance in ensuring patient safety and the quality of care delivered by healthcare professionals. Monitoring equipment (ME), infusion pumps (IP), and mechanical ventilators (MV) are frequently used in intensive care units, but they are subject to technical, human, and process failures that may pose harm to and even cause the death of patients. The aim of this study was to evaluate the risks related to the use of ME, IP, and MV in the adult intensive care unit (AICU) of a public hospital in Brazil, and to investigate the causes of technical complaints and the adverse events associated with them. We hope the outcomes may serve as a basis for the facility to create mechanisms to diminish the risk and increase the safety and quality of care delivered to critical patientsMethods:A 12-month prospective, observational descriptive study was conducted using an active and passive search of processes related to: hospital medical equipment use; available human and material resources; training programs and continuing professional education; equipment disinfection, sterilization, and assembly processes; and the hospital risk management measures regarding the reports and actions for technical, human, and process failures and the adverse events and incidents related to them. All the data collected were checked against current Brazilian legislation and the equipment technical manuals. The root cause of every failure and adverse event was investigated.Results:The active search identified seventy-five reports on technical complaints in the study period: sixty-five were related to IP, six to ME, and four to MV. The reasons for the complaints included: deficiencies in the quantity, qualification, training, and capacity of professionals handling the devices; inadequate disinfection of MV accessories; absence of or difficulty in accessing the equipment technical manuals; and a lack of preventive and corrective maintenance programs. One single adverse event caused by an IP medication error was attributed to a programing error.Conclusions:Failures and deficiencies in the knowledge and management of hospital equipment can potentially increase risks to patients and healthcare professionals. Increasing compliance with Brazil's current legislation related to the technical and operational norms of hospital equipment might create safer practices and improve care quality for critical patients.

МЕТОД ПРОЕКТИРОВАНИЯ СТРАТЕГИИ КРОСС-ПРОДАЖ ПЛАТНЫХ МЕДИЦИНСКИХ УСЛУГ НА ОСНОВЕ ТЕХНОЛОГИИ ИНТЕЛЛЕКТУАЛЬНОГО УПРАВЛЕНИЯ ВЗАИМООТНОШЕНИЯМИ С ПАЦИЕНТАМИ

The method for designing a cross-selling strategy for paid medical services based on services consumption analysis and simulated protability level in the context of clusters and patient proles has been developed. The proposed method allows to increase the e-ciency of health care organizations in conditions of transformation of the nancing mod-el and increasing competition in the market of paid medical services. This method allows to stimulate sales and manage the protability of paid medical services, as well as to reduce the manual labor of employees of planning and economic departments to create cross-sell-ing strategies for the use of free labor and medical equipment.

Regional disparities in medical equipment distribution in the Slovak Republic \u2013 a platform for a health policy regulatory mechanism

BackgroundThis study aims to examine the localisation of selected parameters in the deployment and use of medical equipment in the Slovak Republic and to verify potential regional disparities. The study evaluates the benefits of an analytical platform for regulatory mechanisms in the healthcare system.MethodsThe correspondence analysis is applied to the entire data set containing information regarding medical equipment distribution and mortality.ResultsThe results highlight regional differences in the use of medical equipment throughout the analysed period from 2008 to 2014. The total amount of medical equipment increased slightly to 9192 devices during the time span. In 2014, there was a significant decrease of 16.44%. Disparities are found in the frequencies and structure of medical equipment. In some regions, medical equipment is not present or is present in low numbers.ConclusionsThe results regarding regional disparities demonstrate the regional development of the amount of medical equipment. The deployment of medical equipment is not proportional, and not all of the analysed devices are available in each region. The tests also indicate the appropriateness of the amount of medical equipment and create a platform for further investigation. The results of the analysis suggest the unsuitable distribution of medical equipment throughout the Slovak regions, where there are significant regional disparities. These findings can serve as a monitoring platform to evaluate the accessibility and efficiency of medical equipment usage.Trial registrationNo human participants were involved in the research.

Association of anti-cyclic citrullinated protein antibodies, erosions, and rheumatoid factor with disease activity and work productivity: A patient registry study.

To evaluate associations between the presence of anti-cyclic citrullinated protein antibodies (anti-CCP) and rheumatoid factor (RF) and other outcomes, including joint erosions and both clinical and economic endpoints, in patients with rheumatoid arthritis (RA). Data from the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS), a prospective registry of adult RA patients with established or recent-onset RA, were analyzed. Logistic regression models were constructed to test associations between anti-CCP/RF seropositivity and erosive disease and the presence of anti-CCP/RF seropositivity plus erosive disease and (1) RA severity; (2) hospitalizations; (3) durable medical equipment (DME) use; and (4) worker productivity (e.g., employment status). Covariates in these models included patient age, gender, race, body mass index (BMI), number of comorbidities, and treatment. Among 1309 registrants, those who were positive (vs. negative) for anti-CCP were 2.72 times more likely to have erosions (OR = 2.72; 95% CI: 1.77-4.18; P < 0.001). Individuals positive (vs. negative) for RF were 36% more likely to have erosions (95% CI: 0.88-2.08; P = 0.162). Patients with anti-CCP seropositivity and erosions were significantly more likely to: (1) have higher disease activity as measured by the Disease Activity Score in 28 joints C-reactive protein (DAS28-CRP ≥ 2.6); (2) be hospitalized; (3) use DME; and (4) be unemployed, disabled, or long-term disabled. For the first time in a "real-world" setting including patients with both recent-onset and chronic RA, this study demonstrated that the combination of anti-CCP seropositivity and erosions were significantly associated with more adverse clinical and health-economic consequences, including a lower probability of low disease activity and higher health resource utilization, despite use of biologic disease-modifying antirheumatic drugs by many patients. This dual presentation may signal a need for more intensive therapies, even when observed in patients with chronic, as well as recent-onset, RA. Trial registration [Brigham and Women's Hospital (BWH) Rheumatoid Arthritis Sequential Study; Registry URL: https://clinicaltrials.gov/ct2/show/NCT01793103; ClinicalTrials.gov Identifier NCT01793103].

Radiation safety requirements for training of users of diagnostic X-ray equipment in South Africa

Background. Globally, the aim of requirements regarding the use and ownership of diagnostic medical X-ray equipment is to limit radiation by abiding by the ‘as low as reasonably achievable’ (ALARA) principle. The ignorance of radiographers with regard to radiation safety requirements, however, is currently a cause of concern. The enhancement of the 4-year radiography curriculum leading to a Bachelor’s qualification provides an opportunity to explore the training and assessment to meet, among others, the ALARA principle, which addresses national and international concerns and criteria. Healthcare workers outside the scope of radiography, who are also considered radiation workers, may be even more ignorant and are therefore also implicated. The process of investigation included a contextualisation of the available regulation documents, the Delphi technique to determine the content of the training, and a questionnaire to test students’ knowledge before and after training. Objectives. To determine the content of the radiation safety requirements training and assessment to implement standardised teaching, learning activities and assessment to prepare radiographers as radiation workers well trained for practice. Methods. The content of the radiation safety requirements training was determined with the Delphi technique. Results. Consensus regarding the content of the radiography students’ training was reached and implemented. Furthermore, it guided the development of teaching and learning activities complemented by aligned assessment. Conclusion. Standardised education and assessment for radiation safety requirements have the potential to ensure that radiation safety regulations are implemented optimally in diagnostic imaging.