Using personal monitoring data to derive organ doses for medical radiation workers in the Million Person Study-considerations regarding NCRP Commentary no. 30

The study of low dose and low-dose rate exposure is of central importance in understanding the possible range of health effects from prolonged exposures to radiation. The One Million Person Study of Radiation Workers and Veterans (MPS) of low-dose health effects was designed to evaluate radiation risks among healthy American workers and veterans. The MPS is evaluating low-dose and dose-rate effects, intakes of radioactive elements, cancer and non-cancer outcomes, as well as differences in risks between women and men. Medical radiation workers make up a large group of individuals occupationally exposed to low doses of radiation from external x-ray/gamma exposures. For the MPS, about 100 000 United States medical radiation workers have been selected for study. The approach to the complex dosimetry circumstances for such workers over three to four decades of occupation were initially and broadly described in National Council on Radiation Protection and Measurements (NCRP) Report No. 178. NCRP Commentary No. 30 provides more detail and describes an optimum approach for using personal monitoring data to estimate lung and other organ doses applicable to the cohort and provides specific precautions/considerations applicable to the dosimetry of medical radiation worker organ doses for use in epidemiologic studies. The use of protective aprons creates dosimetric complexity. It is recommended that dose values from dosimeters worn over a protective apron be reduced by a factor of 20 for estimating mean organ doses to tissues located in the torso and that 15% of the marrow should be assumed to remain unshielded for exposure scenarios when aprons are worn. Conversion coefficients relating personal dose equivalent,H_p(10) in mSv, to mean absorbed doses to organs and tissues,D_Tin mGy, for females and males for six exposure scenarios have been determined and presented for use in the MPS. This Memorandum summarises several key points in NCRP Commentary No. 30.

Neutron field characterisation at mixed oxide fuel plant

A neutron field characterisation was conducted at the AREVA Melox Plant to determine the response of passive and active neutron dosemeters for several stages in the mixed oxide fuel manufacturing process. Landauer Europe provides radiation dosimetry to many contractors working at the Melox site. The studies were conducted to assist in determining the neutron radiation fields the workers are exposed to routinely, evaluate the need for specific neutron correction factors and to ensure that the most accurate neutron dose is reported for the Melox Plant workers.

Neutron response characterisation of an OSL neutron dosemeter

The neutron response was characterised for Al(2)O(3):C material coated with (6)Li(2)CO(3). Al(2)O(3):C material, an optically stimulated luminescent (OSL) dosemeter, which is sensitive to both photons and beta radiation but is mostly insensitive to neutron radiation. The Al(2)O(3):C material was coated with (6)Li(2)CO(3) to create a material sensitive to neutrons, beta and photon radiation. In this paper, the neutron response of this new OSL material (OSLN) will be compared with various other neutron measurement technologies in laboratory and field environments.

A method to characterise site, urban and regional ambient background radiation

Control dosemeters are routinely provided to customers to monitor the background radiation so that it can be subtracted from the gross response of the dosemeter to arrive at the occupational dose. Landauer, the largest dosimetry processor in the world with subsidiaries in Australia, Brazil, China, France, Japan, Mexico and the UK, has clients in approximately 130 countries. The Glenwood facility processes over 1.1 million controls per year. This network of clients around the world provides a unique ability to monitor the world's ambient background radiation. Control data can be mined to provide useful historical information regarding ambient background rates and provide a historical baseline for geographical areas. Historical baseline can be used to provide site or region-specific background subtraction values, document the variation in ambient background radiation around a client's site or provide a baseline for measuring the efficiency of clean-up efforts in urban areas after a dirty bomb detonation.

Vitamin D, sunlight exposure, and bone density in elderly African American females of low socioeconomic status

BACKGROUND AND OBJECTIVES

Darker skin pigmentation and aging are known factors influencing the body's ability to synthesize adequate amounts of vitamin D (25OHD). The objective of this study is to determine the 25OHD insufficiency in elderly African American females of low socioeconomic status (SES) in a southern latitude during springtime sun exposure.

METHODS

Patients >or= 70 years old who did not have disorders that might affect vitamin D and calcium absorption/metabolism were enrolled at a community health center. Serum calcium, 25OHD, and intact parathyroid hormone were measured and repeated 6--8 weeks later. Bone mineral density (BMD) scan results were obtained from clinic records.

RESULTS

Most subjects (86.4%) had inadequate 25OHD levels < 32ng/mL, and no clinically significant rise in levels was seen after 6--8 weeks of sun exposure. A quarter of subjects had truly deficient 25OHD levels <or= 15ng/mL. 25OHD levels were positively correlated with BMD only at the lumbar spine. Fifty-two percent of subjects were osteopenic, and 9% were osteoporotic.

CONCLUSIONS

25OHD insufficiency is common among low SES elderly African American women, and springtime sunlight exposure does not cause significant increases in 25OHD. Additionally, this population has low calcium and vitamin D intake from diet, and more women than expected had reduced BMD.

The efficacy and safety of cefovecin in the treatment of feline abscesses and infected wounds

OBJECTIVES

To determine the efficacy and safety of cefovecin for the treatment of bacterial abscesses and wounds in cats at clinics in Germany, France, Spain and the UK.

METHOD

Cats with abscesses or wounds were enrolled. Cats (217) were randomised to treatment with either cefovecin administered by subcutaneous injection at 14 day intervals or amoxicillin/clavulanic acid as twice-daily oral tablets for 14 days. Treatment courses were repeated at 14 day intervals, when deemed necessary. Clinicians assessing lesions were masked to treatment allocation. Only animals with a confirmed pretreatment bacterial pathogen were included in the efficacy analysis. Cases were evaluated 28 days after initiation of the final course of treatment.

RESULTS

Cefovecin was as efficacious as amoxicillin/clavulanic acid, and efficacy was 100 per cent for both treatments.

CLINICAL SIGNIFICANCE

Cefovecin, administered as a single subcutaneous injection repeated at 14 day intervals as required, was shown to be as efficacious as oral amoxicillin/clavulanic acid in the treatment of abscesses/wounds in cats.

Research funding and mentoring in family medicine residencies

BACKGROUND AND OBJECTIVES

This study's purpose was to measure the current status of research funding and mentoring in family medicine residencies and to ascertain what resources are needed to increase residencies' research output.

METHODS

This was a cross-sectional survey of family medicine residency program directors in the United States. We measured grant funding sources, availability of mentors, the likelihood programs could qualify for National Institutes of Health (NIH) K awards, barriers to research, and how these factors varied by program type.

RESULTS

The response rate was 66% (298/453). Medical school-based programs were much more likely to report that their family medicine faculty wrote funded research grants than were community-based medical school affiliated programs (76% versus 32%). The majority of both program types reported that research mentors were available (85% versus 60%). Very few programs of either type were likely to meet the minimum requirements for NIH K01, K08, or K23 awards (29% for medical school programs versus 3% for community programs). The most commonly reported specific resources needed to increase research output were time, money, and more faculty (range 86% to 92% between program types).

CONCLUSIONS

The majority of family medicine residencies did not receive grant funding for research, reported that time and money were the most significant barriers to research, but were ineligible to receive support from NIH K awards. More realistic funding mechanisms are needed to support residency-based research faculty.

Faculty perceptions of the ACGME resident duty hour regulations in family medicine

BACKGROUND AND OBJECTIVES

Accreditation Council for Graduate Medical Education (ACGME) duty hour regulations have significantly changed residency education. Initial research focused heavily on resident experiences, while changes in faculty roles and effects on patient care and resident education have received less attention. This survey examines faculty perceptions of the effect of duty hour changes in academic family medicine.

METHODS

Family medicine faculty members from 15% of ACGME-accredited residencies were surveyed. The survey included demographic information and Likert-type questions about changes in faculty duties, patient care, resident education, and satisfaction with academic medicine.

RESULTS

A total of 368 of 672 surveys were returned; 97% of the 69 surveyed programs were represented. The average faculty workweek was 66 hours, including call. Of respondents, 81% felt that weekly faculty hours were unchanged since duty hours; 19% thought work hours had increased. Faculty felt that residency education and patient care were not positively affected by duty hours. Statistically significant differences were found between perceptions of faculty who did and did not deliver babies. Twenty percent of faculty members are considering leaving academic medicine in relation to duty hours.

CONCLUSIONS

Consistent with research from other specialties, many faculty members perceive that their work roles have increased in certain areas. Resident performance and patient care are not seen to be improved as a result of duty hours. Further research into the unexpected findings involving labor and delivery responsibilities is needed.

Research participation, protected time, and research output by family physicians in family medicine residencies

BACKGROUND AND OBJECTIVES

The Future of Family Medicine project concluded that research must become a greater part of the culture of the specialty. We examined the participation of family physician residency faculty in research, their protected time, and their research output and how these varied by program type.

METHODS

This was a cross-sectional survey of all family medicine residency programs in the United States. The response rate was 66% (298/453).

RESULTS

The majority of programs reported at least one family physician who participates in research, though the medical school-based (MSB) programs reported a higher total number of faculty than the community-based, medical school affiliated (MSA) programs (9.53 versus 2.72) and percentage of faculty (56% versus 37%). Substantially more MSB programs reported that they had at least one family physician with significant protected time for research (48% versus 7% for > 25% protected time) or any protected time (69% for MSB versus 45% for MSA). MSB programs and MSA programs reported similar success at producing at least one poster or paper for national meetings within the last 3 years (63% versus 41%) but not for published papers (86% versus 43%).

CONCLUSIONS

We found that only about half of the family medicine residencies produced any nationally recognized research over a 3-year period and that this represents only a small improvement over the last 10 years. Our findings suggest that more support is needed if research is to become an integral part of the culture of family medicine.

Can family medicine residents predict their performance on the in-training examination?

BACKGROUND AND OBJECTIVES

Evaluation of residents' competence is of great importance in the training of physicians, yet the evaluation process is largely subjective. Faculty and residents frequently rely on self assessments to make decisions regarding curriculum design and electives. The In-training Examination (ITE), the only widely available objective measure of residents' medical knowledge, provides an opportunity to test the reliability of self-assessments. This study's objective was to determine if family medicine residents are able to self-assess their medical knowledge by predicting their performance on the ITE.

METHODS

A survey asking the residents to estimate their performance on the ITE in each of the nine content areas was administered at 13 examination sites just prior to the ITE. Correlation coefficients were calculated for corresponding predicted and actual scores for each resident in each content area. Predictions were also compared to performance according to quartile.

RESULTS

Residents showed little ability to predict their scores in any of the content areas. Residents scoring in either the lowest or highest quartile were least able to predict accurately, with correct predictions ranging from 3% to 23%.

CONCLUSIONS

Residents cannot reliably predict their performance on the ITE. Of special concern are residents scoring in the lowest quartile, since these residents greatly overestimated their performance.

Otitis media in children: use of diagnostic tools by family practice residents

BACKGROUND AND OBJECTIVES

Although otitis media is a common problem in primary care, little is known about the use of diagnostic tools such as pneumatic otoscopy, tympanometry, acoustic reflectometry, or tympanocentesis by family physicians in training.

METHODS

This was a self-reported observational study of family practice residents' use of otitis media diagnostic tools. Twenty-three family practice programs in Texas and Oklahoma were surveyed during November and December 2000. Residents were asked about their use of diagnostic tools, and, if tools were not used, they were asked the reason for not using them. Residents were also asked about the criteria they used to diagnose otitis media, and their responses were compared to criteria recommended by national guideline panels.

RESULTS

The response rate was 61% (n = 316). The percentage of residents using pneumatic otoscopy was 66%, tympanometry 29%, acoustic reflectometry 2%, and tympanocentesis 0%. The most common reasons cited for not using tools were lack of training or unavailability of equipment. Fifty-five percent of family practice residents do not report pneumatic otoscopy for diagnosing otitis media and thus did not use recommended criteria. Faculty training of residents in the use of diagnostic tools was associated with a higher rate of using these tools.

DISCUSSION

Few residents believed that diagnostic tools had no value in the diagnosis of otitis media, but lack of training or equipment problems were reported as contributing to their not using these tools. Half of family practice residents may be inadequately diagnosing middle ear problems since they did not report that pneumatic otoscopy was necessary for diagnosing otitis media. Because training was associated with higher rates of using appropriate diagnostic tools, family medicine faculty can play a significant role in improving the residents' diagnostic skills.

Guidelines for constructing a survey

Many researchers in family medicine use surveys to gather data from colleagues, learners, and patients on their demographics, personal histories, knowledge, behaviors, and attitudes. Well-written surveys are easy for respondents to complete, gather information accurately and consistently, and obtain data that can be analyzed to answer research questions. All levels of family medicine researchers can follow eight steps to develop surveys that produce useful and publishable results: (1) state the problem or need, (2) plan the project, (3) state the research question, (4) review the literature, (5) develop or adapt existing survey items, (6) construct the survey, (7) conduct pilot tests, and (8) administer the survey. After completing this article, readers should be able to (1) state the appropriate uses of survey instruments as research tools and (2) construct and administer a well-designed survey instrument.

Job satisfaction of family practice residents

BACKGROUND AND OBJECTIVES

As new market forces and expanding responsibilities strongly influence our specialty, it is vital to understand issues that affect resident recruitment, retention, and performance. This study evaluated family practice residents' satisfaction with their chosen careers, their individual programs, and many of the other factors that potentially influence and contribute to job satisfaction.

METHODS

Data were collected using a 56-item questionnaire that included demographic information and specific questions regarding residency job satisfaction. The questionnaire was mailed to all 28 Texas family practice residency programs.

RESULTS

We received resultsfrom 75% of surveyed residents. Overall satisfaction with family practice as a specialty" received the highest satisfaction ranking. Satisfaction with 25 various aspects of family practice residency training was significantly higher in community-based programs, compared with university-based programs, and satisfaction increased with year level of training. Items that were ranked higher by community-based residents included satisfaction with their specific residency program, obstetrics experience, overall learning environment, degree of autonomy, and relationship with specialists.

CONCLUSIONS

This report demonstrates a strong degree of overall job satisfaction among family practice residents. In general, residents in community-based programs have a higher level of job satisfaction, compared with residents in university-based programs, and satisfaction increases with vear level of training.