Integrated Radiological Services (United Kingdom)

Many centres across the UK and Ireland anecdotally report using a 'modified ketogenic diet' (MKD) as a treatment for refractory epilepsy. Although a MKD is within the spectrum of ketogenic diets (KDs), there is little literature reporting upon its definition, use or clinical effectiveness. We aimed to understand the core principles of MKD practice and to assess whether and how the MKD differs from other KD protocols. An online survey, designed by a consensus group of ketogenic dietitians, was circulated to 39 KD centres across the UK and Ireland. It consisted of 35 questions regarding dietetic practice when providing MKD. Eighteen centres completed the questionnaire: 13 paediatric, three adult and two combined centres. All dietitians based MKD 'prescriptions' on estimated total energy requirements. The average macronutrient profile was 75% fat and 5% carbohydrate, with protein adlibitum. Carbohydrate and fat targets were implemented via weighed portions (carbohydrate lists n=18; fat lists n=13) and 'household measures' (carbohydrate lists n=2; fat lists n=3). Of the centres, 94% (n=17) adjusted macronutrients over time; these decisions were based on ketone levels and seizures in most cases (83%; n=14). Ketogenic nutritional products available on prescription were used by 10 centres (56%)when initiating and by all centres when 'fine-tuning' the MKD. A modified ketogenic diet in the UK and Ireland is a hybrid KD, adopting principles from other established KD protocols and defining new elements unique to the MKD. Further research into the clinical and cost-effectiveness of MKD would be of benefit.

This article discusses recent developments in dissident Irish republicanism and some of the arguments advanced to explain its emergence as a factor in Northern Irish politics. In particular it considers those explanations which define these new armed groups as either the latest manifestation of a historically determined Irish republican tradition or simply as ‘residual terrorist groups’ left behind by Provisional republicanism's movement into the constitutional mainstream in the 1990s. It rejects these arguments as ahistorical and schematic, and instead suggests that the dynamics and trajectory of dissident republicanism are shaped instead by the inherent tensions and structures of ‘the new Northern Ireland’. It goes on to compare the contemporary political, social and economic forces that produce the dissidents with the conditions that created the Provisionals as in the early 1970s and concludes that whilst these new groups will continue to pose a threat to the ‘normalization’ of the new dispensation they will not be successful as their republican forebears in mobilizing a significant and sustained challenge to the Northern Irish state.

Dose Audits have to be carried out in x-ray departments. Integrated Radiological Services (IRS) Limited has historically performed these for sites in the North West of England by having a technician on-site to collect patient dose information. This data would then be entered in an application called QADDS (Quality Assurance Dose Data System) where a dose could be calculated. However, whilst being effective, the process was time consuming and lead to large resource expenditure for relatively small amounts of data. Large amounts of data for examinations are routinely recorded by radiographers on their site’s Radiology Information System (RIS). In theory, RIS data should be able to form the basis of a patient dose audit. Furthermore, a bespoke application should be able to transfer this data from RIS to QADDS with the minimum of human input.

Patient safety is a fundamental requirement of modern health-care systems and the application of information technology (IT) to this activity should have improvements in the area as one of its goals. Indeed, ensuring that the diagnostic IT strategy is optimized, for example, the use of IT in service redesign or data analysis, forms one of the main platforms for the National Framework for Service Improvement in Radiology. This paper presents both the concept behind and the results of a project that has been under way in the UK involving St Helens and Knowsley NHS Trust and IRS Ltd concerned with implementing effective IT-driven scientific support in the field of medical radiation protection. Locally developed software is employed in assessing, managing, and analysing patient dose data arising from X-ray examinations performed in the busy department of a large district general hospital (DGH). Such data are analysed in a variety of ways, for example, over time and according to location (department or X-ray room). This analysis not only provides a measure of performance against nationally agreed dose reference levels (DRLs) but also enables a detailed analysis of any variations as well as the establishment of local DRLs (performance indicators). This process provides quantitative input to management strategies aimed at service improvement. Such strategies are geared towards the support of the Ionizing Radiations (Medical Exposures) Regulations 2000 as well as implementation of quality-management principles at the heart of radiology practices.