Journal articles
Shepherd J, Lourida I, Meertens RM (In Press). Radiographer-led Discharge for Emergency Care Patients, Requiring Projection Radiography of Minor Musculoskeletal Injuries: a Scoping Review.
Abstract:
Radiographer-led Discharge for Emergency Care Patients, Requiring Projection Radiography of Minor Musculoskeletal Injuries: a Scoping Review
Abstract
. BackgroundPressure on emergency departments (ED) from increased attendance for minor injuries has been recognised in the United Kingdom. Radiographer-led discharge (RLD) has potential for improving efficiency, through radiographers trained to discharge patients or refer them for treatment at the point of image assessment. This review aims to scope all RLD literature and identify research assessing the merits of RLD and requirements to enable implementation.MethodsWe conducted a scoping review of studies relating to RLD of emergency care patients requiring projection radiography of minor musculoskeletal injuries. MEDLINE, Embase and CINAHL, relevant radiography journals and grey literature were searched. Articles were reviewed and the full texts of selected studies were screened against eligibility criteria. The data were extracted, collated and a narrative synthesis completed. ResultsNine studies with varying study designs were included in the review. The small number of studies was possibly due to a generally low research uptake in radiography. The main outcome for five studies was reduced length of stay in ED, with recall and re-attendance to ED a primary outcome in one study and secondary outcome for three other studies. The potential for increased capacity for ED staff was recognised. Radiographers identified a concern regarding the risk of litigation and incentive of increased salary when considering RLD. The studies were broadly radiographer focussed, despite RLD spanning ED and Radiology.ConclusionThere were a low number of RLD active radiographers, likely to be motivated individuals. However, RLD has potential for generalisability with protocol variations evident, all producing similar positive outcomes. Understanding radiography and ED culture could clarify facilitators for RLD to be utilised more sustainably into the future. Cost effectiveness studies, action research within ED, and cluster randomised controlled trial with process evaluation are needed to fully understand the potential for RLD. The cost effectiveness of RLD may provide financial support for training radiographers and increasing their salary, with potential future benefit of reduction in workload within ED. RLD implementation would require an inter-professional approach achieved by understanding ED staff and patient perspectives and ensuring these views are central to RLD implementation.
Abstract.
Meertens R, Hancock A, Hyde E (2023). Editorial: Patient voice and the patient experience.
Radiography (Lond),
29 Suppl 1, S1-S2.
Author URL.
Manning F, Mahmoud A, Meertens R (2023). Understanding patient views and acceptability of predictive software in osteoporosis identification. Radiography, 29(6), 1046-1053.
Alghamdi F, Owen R, Ashton REM, Obotiba AD, Meertens RM, Hyde E, Faghy MA, Knapp KM, Rogers P, Strain WD, et al (2022). Post-acute COVID syndrome (long COVID): What should radiographers know and the potential impact for imaging services. Radiography, 28, S93-S99.
Shepherd J, Meertens RM, Lourida I (2022). Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review (vol 22, 70, 2022).
BMC EMERGENCY MEDICINE,
22(1).
Author URL.
Shepherd J, Lourida I, Meertens RM (2022). Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review.
BMC Emerg Med,
22(1).
Abstract:
Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review.
BACKGROUND: Pressure on emergency departments (EDs) from increased attendance for minor injuries has been recognised in the United Kingdom. Radiographer-led discharge (RLD) has potential for improving efficiency, through radiographers trained to discharge patients or refer them for treatment at the point of image assessment. This review aims to scope all RLD literature and identify research assessing the merits of RLD and requirements to enable implementation. METHODS: We conducted a scoping review of studies relating to RLD of emergency care patients requiring projection radiography of minor musculoskeletal (MSK) injuries. MEDLINE, Embase and CINAHL, relevant radiography journals and grey literature were searched. Articles were reviewed and the full texts of selected studies were screened against eligibility criteria. The data were extracted, collated and a narrative synthesis completed. RESULTS: Seven studies with varying study designs were included in the review. The small number of studies was possibly due to a generally low research uptake in radiography. The main outcome for four studies was reduced length of stay in ED, with recall and re-attendance to ED a primary outcome in one study and secondary outcome for two other studies. The potential for increased efficiency in the minor MSK pathway patient pathway and capacity for ED staff was recognised. Radiographers identified a concern regarding the risk of litigation and incentive of increased salary when considering RLD. The studies were broadly radiographer focussed, despite RLD spanning ED and Radiology. CONCLUSION: There were a low number of RLD active radiographers, likely to be motivated individuals. However, RLD has potential for generalisability with protocol variations evident, all producing similar positive outcomes. Understanding radiography and ED culture could clarify facilitators for RLD to be utilised more sustainably into the future. Cost effectiveness studies, action research within ED, and cluster randomised controlled trial with process evaluation are needed to fully understand the potential for RLD. The cost effectiveness of RLD may provide financial support for training radiographers and increasing their salary, with potential future benefit of reduction in workload within ED. RLD implementation would require an inter-professional approach achieved by understanding ED staff and patient perspectives and ensuring these views are central to RLD implementation.
Abstract.
Author URL.
Hudson DM, Heales C, Meertens R (2022). Review of claustrophobia incidence in MRI: a service evaluation of current rates across a multi-centre service. Radiography, 28(3), 780-787.
Meertens R, Knapp KM, Strain WD, Casanova F, Ball S, Fulford J, Thorn C (2021). In vivo Measurement of Intraosseous Vascular Haemodynamic Markers in Human Bone Tissue Utilising Near Infrared Spectroscopy.
Frontiers in Physiology,
12Abstract:
In vivo Measurement of Intraosseous Vascular Haemodynamic Markers in Human Bone Tissue Utilising Near Infrared Spectroscopy
Objective:Poor vascular health is associated with reduced bone strength and increased risk of fragility fracture. However, direct measurement of intraosseous vascular health is difficult due to the density and mineral content of bone. We investigated the feasibility of using a commercially available continuous wave near infrared spectroscopy (NIRS) system for the investigation of vascular haemodynamics in human bonein vivo.Approach:An arterial occlusion (AO) protocol was developed for obtaining haemodynamic measurements of the proximal tibia and lateral calf, including assessment of the protocol’s intra operator reproducibility. For 36 participants, intraosseous haemodynamics derived by NIRS were compared to alternative tests of bone health based on dual x-ray absorptiometry (DXA) testing and MRI.Main Results:Near infrared spectroscopy markers of haemodynamics of the proximal tibia demonstrated acceptable reproducibility, comparable with reproducibility assessments of alternative modalities measuring intraosseous haemodynamics, and the use of NIRS for measuring muscle. Novel associations have been demonstrated between haemodynamic markers of bone measured with NIRS and body composition and bone mineral density (BMD) measurements obtained with both DXA and MRI.Significance:Near infrared spectroscopy provides inexpensive, non-invasive, safe, and real time data on changes in oxygenated and deoxygenated haemoglobin concentration in bone at the proximal tibia. This study has demonstrated the potential for NIRS to contribute to research investigating the pathophysiological role of vascular dysfunction within bone tissue, but also the limitations and need for further development of NIRS technology.
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Rimes SJ, Knapp KM, Meertens RM, Fox DL (2019). Computed tomography colonography: Radiographer independent preliminary clinical evaluation for intraluminal pathology.
Radiography,
25(4), 359-364.
Abstract:
Computed tomography colonography: Radiographer independent preliminary clinical evaluation for intraluminal pathology
Introduction: We evaluated the reporting competency of radiographers providing preliminary clinical evaluations (PCE) for intraluminal pathology of computed tomography colonography (CTC). Method: Following validation of a suitable tool, audit was undertaken to compare radiographer PCE against radiology reports. A database was designed to capture radiographer and radiologist report data. The radiographer's PCE of intraluminal pathology was given a score, the “pathology discrepancy and significance” (PDS) score based on the pathology present, any discrepancy between the PCE and the final report, and the significance of that discrepancy on the management of the patient. Agreement was assessed using percentage agreement and Kappa coefficient. Significant discrepancies between findings were compared against endoscopy and pathology reports. Results: There was agreement or insignificant discrepancy between the radiographer PCE and the radiology report for 1736 patients, representing 97.0% of cases. There was a significant discrepancy between findings in 2.8% of cases and a major discrepancy recorded for 0.2% of cases. There was a 98.4% agreement in the 229 cases where significant pathologies were present. Conclusion: from a database of 1815 studies acquired over three years and representing work done in a clinical environment, this study indicates a potential for trained radiographers to provide a PCE of intraluminal pathology.
Abstract.
van den Heuvel J, Punch A, Aweidah L, Meertens R, Lewis S (2019). Optimizing Projectional Radiographic Imaging of the Abdomen of Obese Patients: an e-Delphi Study.
Journal of Medical Imaging and Radiation Sciences,
50(2), 289-296.
Abstract:
Optimizing Projectional Radiographic Imaging of the Abdomen of Obese Patients: an e-Delphi Study
Purpose: Obesity is increasing in prevalence globally, with increased demands placed on radiology departments to image obese patients to assist with diagnosis and management. The aim of this study was to determine perceived best practice techniques currently used in clinical practice for projectional radiography of the abdomen for obese patients with the aim to help elucidate areas for future research and education needs in this field. Experimental Design: a two round e-Delphi study was undertaken to establish a consensus within a reference group of expert Australian clinical educator diagnostic radiographers (CEDRs). Initially, a conceptual map of issues regarding imaging obese patients was undertaken by analysing interview transcripts of 12 CEDRs. This informed an online questionnaire design used in Delphi rounds 1 and 2. A consensus threshold was set
Abstract.
Gundry M, Knapp K, Meertens R, Meakin JR (2018). Computer-aided detection in musculoskeletal projection radiography: a systematic review.
Radiography,
24, 165-174.
Abstract:
Computer-aided detection in musculoskeletal projection radiography: a systematic review
Objectives: to investigated the accuracy of computer-aided detection (CAD) software in musculoskeletal projection radiography via a systematic review. Key findings: Following selection screening, eligible studies were assessed for bias, and had their study characteristics extracted resulting in 22 studies being included. of these 22 three studies had tested their CAD software in a clinical setting; the first study investigated vertebral fractures, reporting a sensitivity score of 69.3% with CAD, compared to 59.8% sensitivity without CAD. The second study tested dental caries diagnosis producing a sensitivity score of 68.8% and specificity of 94.1% with CAD, compared to sensitivity of 39.3% and specificity of 96.7% without CAD. The third indicated osteoporotic cases based on CAD, resulting in 100% sensitivity and 81.3% specificity. Conclusion: the current evidence reported shows a lack of development into the clinical testing phase; however the research does show future promise in the variation of different CAD systems.
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Knapp KM, Meertens RM, Seymour R (2018). Imaging in osteoporosis: an update. Geriatric Medicine, 48, 10-12.
Meertens RM, Casanova F, Knapp KM, Thorn C, Strain WD (2018). Use of Near-Infrared Systems for Investigations of Hemodynamics in Human in Vivo Bone Tissue: a Systematic Review. Journal of Orthopaedic Research
Meertens RM, Knapp KM, Strain WD, Casanova F (2016). The Effects of Lumbar Sympathectomy on Bone and Soft Tissue Haemodynamics of the Leg recorded using Near Infrared Spectroscopy: a Case Report. Journal of Biomedical Engineering and Informatics, 3, 28-32.
Meertens R (2016). Utilisation of a peer assisted learning scheme in an undergraduate diagnostic radiography module.
Radiography,
22(1), e69-e74.
Abstract:
Utilisation of a peer assisted learning scheme in an undergraduate diagnostic radiography module
Background: Peer to peer support programmes involve students supporting each other in either an educational, social and/or pastoral way. This is now common place in higher education institutes and has been proven to decrease student attrition and improve grades. Aim: to evaluate a peer assisted learning scheme (PALS) within the University of Exeter undergraduate programme, where final year (stage 3) students held extra-curricular teaching sessions in an on-campus X-ray room throughout the academic term to support a first year (stage 1) module introducing basic projectional radiographic examinations, radiation safety, patient care and radiographic equipment. PALS sessions were unstructured and as such could involve roleplaying radiographic examinations, revisiting lecture material and/or discussing hospital placement or pastoral issues. Methods: Brookfield's four lenses of critical reflection were used. 16 of 63 stage 1 students and 9 of 29 stage 3 students were electronically surveyed upon completion of the PALS sessions. Relevant colleagues and educational specialists were also informally interviewed. These were put in context with autobiographical reflections and the existing literature base on PALS. Results: all agreed that the sessions provided a good environment for stage 1 students to improve their practical skills, revise lecture content, and gain confidence for upcoming clinical placements. Stage 3 students gained experience teaching students, an essential role of a graduate radiographer's job. Improvements around recruiting stage 3 peer leaders, sustainability, timetabling and session structure were explored. Conclusion: the PALS proved to be a successful initiative within the undergraduate programme and will be continued into the future.
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Meertens RM, Strain WD, Knapp KM (2015). A Review of the Mechanisms, Diagnosis and Preventative Treatment of Osteoporotic Fragility Fractures in Patients with Type 2 Diabetes Mellitus.
Journal of Endocrinology and Metabolism,
Volume 5(Number 1-2), 157-162.
Abstract:
A Review of the Mechanisms, Diagnosis and Preventative Treatment of Osteoporotic Fragility Fractures in Patients with Type 2 Diabetes Mellitus
The primary association of both type 2 diabetes mellitus (T2DM) and fragility fractures with age has become cause for concern in the developed world, with T2DM now considered an independent risk factor for an increased risk of fragility fracture. The increased susceptibility to fragility fracture associated with T2DM has wide ranging and increasing socioeconomic, morbidity and mortality effects. As the incidence of T2DM increases, understanding the mechanisms behind why T2DM is a causative risk factor to decreased bone health is an important step. These may be split into two broad categories: those that involve an increased risk of falling, and those mechanisms that make fragility fracture after falling more likely due to detrimental changes to bone strength. The latter is not definitively understood making diagnosis in T2DM populations difficult. Current diagnostic methods do not sufficiently account for the unique endocrinological effects of T2DM on bone. New markers for identifying fragility fracture risk in patients with T2DM are required to overcome the paradoxical increase in bone mineral density (BMD) in these populations, and the shortcomings of predictive algorithms and dual energy X-ray absorptiometry (DXA) in identifying fracture risk in T2DM populations. Earlier identification of patients with T2DM who are at risk of fragility fracture is important, as these patients are not as responsive to current preventative medical interventions as those without T2DM, although there are also adoptive lifestyle changes that can help.
Abstract.
Knapp K, Meertens R, Ashton LR, Hopkins S (2015). Dual energy x-ray absorptiometry beyond bone mineral density measurement: vertebral fracture assessment. Imaging and Oncology for Imaging and Therapy Professionals, 48-53.
Rimes SJ, Fox D, Knapp KM, Meertens R (2015). The development and evaluation of an audit tool for measuring reporting accuracy of radiographers compared with radiologists for intra-luminal pathology detected at computed tomography colonography (CTC).
Radiography,
21(3), 264-268.
Abstract:
The development and evaluation of an audit tool for measuring reporting accuracy of radiographers compared with radiologists for intra-luminal pathology detected at computed tomography colonography (CTC)
Objective: to design and test an audit tool to measure the reporting accuracy of radiographers using radiologist reports as the gold standard. Design: a database was designed to capture radiographer and radiologist report data. The radiographer preliminary evaluation of intraluminal pathology was given a score (PDS score) by the reporting radiologist based on the pathology present, the discrepancy between the preliminary evaluation and the final report and the significance of that discrepancy on the clinical management of the patient. To test the reliability of this scoring system, 30 randomly selected cases (n=1815) were retrospectively compared and assessed for accuracy using the PDS score by 3 independent practitioners. Inter rater reliability was assessed using percentage agreement and kappa scores. Results: There was 100% agreement between participants for all significant pathologies. Inter rater agreement was 80-93% for normal studies and insignificant pathologies. Conclusion: Results indicate that the tool provides a practical, easy to use and reliable method to record, monitor and evaluate a preliminary evaluation of the colon by radiographers.
Abstract.
Meertens R, Brealey S, Nightingale J, McCoubrie P (2013). Diagnostic accuracy of radiographer reporting of computed tomography colonography examinations: a systematic review. Clinical Radiology
Knapp KM, Meertens RM, Seymour R (2013). Imaging in Osteoporosis. CME Journal: Geriatric Medicine, 10
Conferences
Meertens R, Gundry M (2023). PRE-CLINICAL STUDY EVIDENCING AN OPPORTUNISTIC SCREENING APPROACH IN SECONDARY CARE TO IMPROVE PRIMARY CARE REFERRAL FOR PATIENTS AT HEIGHTENED FRACTURE RISK. Royal Osteoporosis Society Conference 2023. 13th - 14th Sep 2023.
Meertens R, Gundry M (2023). RADIAL BONE DENSITY MEASUREMENT AS a PREDICTOR OF OSTEOPOROSIS AND 10- YEAR FRACTURE RISK AT THE FEMORAL NECK – AN OPTION FOR TREATMENT DECISIONS WHERE FEMORAL NECK AREAL BONE MINERAL DENSITY CANNOT BE OBTAINED?. Royal Osteoporosis Society Conference 2023. 13th - 14th Sep 2023.
Meertens R, Knapp K, Casanova F, Ball S, Strain W (2020). Near infrared spectroscopy for the investigation of vascular haemodynamics in human bone in vivo. Bone Research Society Annual Meeting. 6th - 8th Jul 2020.
Meertens R, Knapp K, Casanova F, Ball S, Fulford J, Merson S, Strain W (2020). Sex-based differences in vascular haemodynamics at the proximal tibia. European Congress of Radiology. 15th - 19th Jul 2020.
Meertens R, Knapp K, Casanova F, Ball S, Fulford J, Merson S, Strain W (2020). Vascular measurements of the proximal tibia and their associations with bone mineral density. European Congress of Radiology. 15th - 19th Jul 2020.
Meertens RM, Knapp KM, Casanova F, Ball SE, Strain WD (2019). Exploring the potential relationships between microvascular haemodynamics and density in bone: a feasibility study utilising near infrared spectroscopy. UKIO 2019. 10th - 12th Jun 2019.
Gundry M, Meertens RM, Meakin JR, Knapp KM (2017). Computer-aided detection in musculoskeletal plain radiography: a systematic review.
Abstract:
Computer-aided detection in musculoskeletal plain radiography: a systematic review.
Abstract.
Meertens RM, Casanova F, Strain WD, Knapp K, Thorn C (2017). The use of near-infrared systems for investigations of microvascular haemodynamics in human in vivo bone tissue: a systematic review. International Society of Oxygen Transfer to Tissue Annual Meeting 2017. 19th - 23rd Aug 2017.
Meertens R, Knapp K, Strain D, Casanova F (2016). NEAR INFRARED SPECTROSCOPY: a POTENTIAL TOOL FOR ASSESSING HAEMODYNAMIC MARKERS OF THE MICROVASCULAR BLOOD SUPPLY WITHIN BONE TISSUE.
Author URL.
Meertens R (2016). Peer Assisted Learning in Diagnostic Radiography. SCoR Achieving Excellence in Radiography Education and Research Conference. 25th - 26th Nov 2016.
Al-Rubeyi S, Farah W, Furmully M, Meertens R, Shepherd J, Green D, Strain WD, Knapp KM (2016). Vitamin D deficiency and insufficiency in the radiography population: Are we at risk?.
Abstract:
Vitamin D deficiency and insufficiency in the radiography population: Are we at risk?
Abstract.
Meertens RM (2015). An Evaluation of Service Users as an Educational Resource in an Undergraduate Diagnostic Radiography Module. UKRC 2015. 29th Jun - 1st Jul 2015.