The six-minute walk test (6MWT) is a self-paced, submaximal exercise test used to assess functional exercise capacity in patients with chronic diseases (Chang 2006, Solway et al 2001). It has been used widely in adults, and is being utilised increasingly in paediatric populations; it has been used as an estimate of physical fitness in, for example, children with severe cardiopulmonary disease, cystic fibrosis, and juvenile idiopathic arthritis (Hassan et al 2010).
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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 maintainingimage 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 threeis 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 forpaediatric 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.
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Within paediatric palliative care, it is essential for families and providers to have open, equal, and trusting relationships. In practice, however, building relationships can be challenging. Investing in better understanding the differences in each other's frames of reference and underlying values seems important. Wonder Lab practices provide a space to explore these differences by focusing together on life phenomena in curious and Socratic ways. Wonder Labs were organised with parents, healthcare professionals, and students involved in Dutch paediatric palliative care. The aim of this study was to develop an understanding of how participants experienced participating in Wonder Labs. We conducted twenty in-depth interviews with Wonder Lab participants and used inductive thematic analysis for data interpretation. Five themes were identified: Slowing down, Appreciating stories, Becoming vulnerable, Opening up and diving in, and Reframing perspectives. Participating in Wonder Labs allowed mothers, healthcare professionals, and students to contribute to deepening experiences and gain an expanded understanding of what is at play in caring for children with life-limiting and life-threatening conditions. Through working in pluralised groups, frames of reference and understandings complemented each other and could change. Participants often adopted a more open attitude towards others involved in care after participating and adapted day-to-day practices. Deliberating within paediatric palliative care on sensitive issues and their underlying personal and professional beliefs and values must be part of working together, without specific care situations being the catalyst. This may foster the mutual understanding needed in searching for quality of life, death, and bereavement.
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Objectives: Children have a greater risk from radiation, per unit dose, due to increased radiosensitivity and longer life expectancies. It is of paramount importance to reduce the radiation dose received by children.This research concerns chest CT examinations on paediatric patients. The purpose of this study was to compare the image quality and the dose received from imaging with images reconstructed with filtered back projection (FBP) and five strengths of Sinogram-Affirmed Iterative Reconstruction (SAFIRE).Methods: Using a multi-slice CT scanner, six series of images were taken of a paediatric phantom. Two kVp values (80 and 110), 3 mAs values (25, 50 and 100) and 2 slice thicknesses (1 mm and 3 mm) were used. All images were reconstructed with FBP and five strengths of SAFIRE. Ten observers evaluatedvisual image quality. Dose was measured using CT-Expo.Results: FBP required a higher dose than all SAFIRE strengths to obtain the same image quality for sharpness and noise. For sharpness and contrast image quality ratings of 4, FBP required doses of 6.4 and 6.8 mSv respectively. SAFIRE 5 required doses of 3.4 and 4.3 mSv respectively. Clinical acceptance rate was improved by the higher voltage (110 kV) for all images in comparison to 80 kV, which required a higher dose for acceptable image quality. 3 mm images were typically better quality than 1 mm images.Conclusion: SAFIRE 5 was optimal for dose reduction and image quality
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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 updatingto 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 theireffects 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.
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Background: The use of patient-reported outcomes to improve burn care increases. Little is known on burn patients’ views on what outcomes are most important, and about preferences regarding online Patient Reported Outcome Measures (PROMs). Therefore, this study assessed what outcomes matter most to patients, and gained insights into patient preferences towards the use of online PROMs. Methods: Adult patients (≥18 years old), 3–36 months after injury completed a survey measuring importance of outcomes, separately for three time periods: during admission, short-term (< 6 months) and long-term (6–24 months) after burn injury. Both open and closed-ended questions were used. Furthermore, preferences regarding the use of patient-reported outcome measures in burn care were queried. Results: A total of 140 patients were included (response rate: 27%). ‘Not having pain’ and ‘good wound healing’ were identified as very important outcomes. Also, ‘physical functioning at pre-injury level’, ‘being independent’ and ‘taking care of yourself’ were considered very important outcomes. The top-ten of most important outcomes largely overlapped in all three time periods. Most patients (84%) had no problems with online questionnaires, and many (67%) indicated that it should take up to 15 minutes. Patients’ opinions differed widely on the preferred frequency of follow-up. Conclusions: Not having pain and good wound healing were considered very important during the whole recovery of burns; in addition, physical functioning at pre-injury level, being independent, and taking care of yourself were deemed very important in the short and long-term. These outcomes are recommended to be used in burn care and research, although careful selection of outcomes remains crucial as patients prefer online questionnaires up to 15 minutes.
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Background: Burn scar maturation can take several years but is generally studied shortly after injury. Therefore, we investigated patient-reported scar quality up to 5–7 years post-burn. Methods: Patients with ≤ 20 % total body surface area burned completed the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS 2.0) on the same scar at 3, > 18 months (median 28 months) and 5–7 years (median 63 months) post-burn. Results: Fifty-eight patients (21 children; 37 adults) with a median total body surface area burned (TBSA) of 6.3 % participated. Average patient-reported scar quality (POSAS score) was generally worst at 3 months (median score: 4.2), best at 28 months (median score: 2.2) and intermediate at 63 months post-burn (median score: 3.4) (p < 0.001). Many patients (66 %) reported a median 1.8 point higher (worse) POSAS score at 63 months compared to 28 months post-burn, whereas 14 % reported an identical, and 21 % a lower (better) score. At any assessment, largest differences with normal skin were reported for scar colour. Univariate predictive factors of long-term patient-reported scar quality were scar quality at 3 months (p = 0.002) and 28 months post-burn (p < 0.001), full-thickness burn size (p = 0.033), length of hospital stay (p = 0.003), and number of surgeries (p < 0.001). Conclusion: Two-thirds of patients with burns up to 20 % TBSA scored the quality of their scars worse at 63 months compared to 28 months post-burn. Whether this corresponds to increased dissatisfaction with scars in the long term should be further investigated. These new insights add to the body of knowledge on scar maturation and underscores the importance of discussing patients’ expectations.
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Introduction: The Netherlands does not have a national guideline for performing radiographic examinations on pregnant patients. Radiographic examination is a generic term for all examinations performed using ionizing radiation, including but not limited to radiographs, fluoroscopy and computed tomography. A pilot study amongst radiographers (Medical Radiation Technologists (MRTs)) showed that standardized practice of radiographic examinations on pregnant women is not evident between Radiology departments and that there is a need for a national guideline as the varying practice methods may lead to confusion and uncertainty amongst both patients and MRTs. Methods: Focus groups consisting of MRTs from several Radiology departments within the Netherlands were used to map ideas and requirements as to what should be included in the national guideline. Nine focus group sessions were organized with a total of 52 participants. Using a previous review (Wit, Fleur; Vroonland, Colinda; Bijwaard H. Pre-natal X-ray exposure and the risk of developing paediatric cancer; a systematic review of risk factors and a comparison of international guidelines. Health Physics 2021; 121 (3):225e233), the following key points were chosen as discussion topics for the focus group sessions: dose reduction, confirming pregnancy and risk communication. Results: Results showed that the participating MRTs did not agree on the use of lead aprons. That the national guideline should include standardized methods to adjust parameters to decrease radiation dose. Focus group participants find it difficult to ask a patient's pregnancy status, especially when dealing with relatively young and old (er) patients. When communicating the level of risk associated with a radiographic examination the participating MRTs would like to be able to use examples and comparisons, preferably by means of a multilingual website. Conclusion: A national guideline must include information on justification, available alternatives, dose reductions methods and confirmation of pregnancy requirements when fetal dose is a significant risk. Implications for practice: A national guideline ensures standardized practice can be implemented in Radiology departments, increasing clarity of the issues for both patients and MRTs.
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Background: Computed tomography (CT) is one of the most used modalities for diagnostics in paediatric populations, which is a concern as it also delivers a high patient dose. Research has focused on developing computer algorithms that provide better image quality at lower dose. The iterative reconstruction algorithm Sinogram-Affirmed Iterative Reconstruction (SAFIRE) was introduced as a new technique that reduces noise to increase image quality.Purpose: The aim of this study is to compare SAFIRE with the current gold standard, Filtered Back Projection (FBP), and assess whether SAFIRE alone permits a reduction in dose while maintaining image quality in paediatric head CT.Methods: Images were collected using a paediatric head phantom using a SIEMENS SOMATOMPERSPECTIVE 128 modulated acquisition. 54 images were reconstructed using FBP and 5 different strengths of SAFIRE. Objective measures of image quality were determined by measuring SNR and CNR. Visual measures of image quality were determined by 17 observers with different radiographic experiences. Images were randomized and displayed using 2AFC; observers scored the images answering 5 questions using a Likert scale.Results: At different dose levels, SAFIRE significantly increased SNR (up to 54%) in the acquired images compared to FBP at 80kVp (5.2-8.4), 110kVp (8.2-12.3), 130kVp (8.8-13.1). Visual image quality was higher with increasing SAFIRE strength. The highest image quality was scored with SAFIRE level 3and higher.Conclusion: The SAFIRE algorithm is suitable for image noise reduction in paediatric head CT. Our data demonstrates that SAFIRE enhances SNR while reducing noise with a possible reduction of dose of 68%.
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Objective: Despite the increasing availability of eRehabilitation, its use remains limited. The aim of this study was to assess factors associated with willingness to use eRehabilitation. Design: Cross-sectional survey. Subjects: Stroke patients, informal caregivers, health-care professionals. Methods: The survey included personal characteristics, willingness to use eRehabilitation (yes/no) and barri-ers/facilitators influencing this willingness (4-point scale). Barriers/facilitators were merged into factors. The association between these factors and willingness to use eRehabilitation was assessed using logistic regression analyses. Results: Overall, 125 patients, 43 informal caregivers and 105 healthcare professionals participated in the study. Willingness to use eRehabilitation was positively influenced by perceived patient benefits (e.g. reduced travel time, increased motivation, better outcomes), among patients (odds ratio (OR) 2.68; 95% confidence interval (95% CI) 1.34–5.33), informal caregivers (OR 8.98; 95% CI 1.70–47.33) and healthcare professionals (OR 6.25; 95% CI 1.17–10.48). Insufficient knowledge decreased willingness to use eRehabilitation among pa-tients (OR 0.36, 95% CI 0.17–0.74). Limitations of the study include low response rates and possible response bias. Conclusion: Differences were found between patients/informal caregivers and healthcare professionals. Ho-wever, for both groups, perceived benefits of the use of eRehabilitation facilitated willingness to use eRehabili-tation. Further research is needed to determine the benefits of such programs, and inform all users about the potential benefits, and how to use eRehabilitation. Lay Abstract The use of digital eRehabilitation after stroke (e.g. in serious games, e-consultation and education) is increasing. However, the use of eRehabilitation in daily practice is limited. As a first step in increasing the use of eRehabilitation in stroke care, this study examined which factors influence the willingness of stroke patients, informal caregivers and healthcare professionals to use eRehabilitation. Beliefs about the benefits of eRehabilitation were found to have the largest positive impact on willingness to use eRehabilitation. These benefits included reduced travel time, increased adherence to therapy or motivation, and better health outcomes. The willingness to use eRehabilitation is limited by a lack of knowledge about how to use eRehabilitation.
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