BACKGROUND

Mobile clinics offer crucial healthcare services, including X-ray examinations, to underserved communities. Minimizing image repeats in this setting is vital due to radiation exposure, patient inconvenience, and cost implications.

OBJECTIVES

This study investigated the prevalence and causes of image repeat in conventional radiography performed within mobile clinics in the Philippines.

METHODS

A retrospective review analyzed data from five mobile clinics located in two highly urbanized cities in the Philippines from July to December 2023). Radiology staff assessed image quality, with suboptimal images requiring retakes. Reasons for rejection were categorized.

RESULTS

Out of 871 radiographs taken, 118 (13.55%) were repeated. Vertebrae and pelvic girdle images had the highest repeat rates (33.33%). Positioning errors were the most common cause (44.07%), followed by underexposure and overexposure.

CONCLUSION

This study identified a concerning repeat rate (13.55%) for mobile X-rays, primarily due to improper patient positioning, particularly for specific body parts. Targeted training programs and stricter protocols for mobile clinic staff are needed. Radiography education should also emphasize these skills, potentially through collaboration with mobile clinic operators to ensure graduates are prepared for the unique challenges of this environment.

Mobile Health Units ; Patient Positioning ; Radiography ; X-rays ; X-ray Film

BACKGROUND

Mobile clinics offer crucial healthcare services, including X-ray examinations, to underserved communities. Minimizing image repeats in this setting is vital due to radiation exposure, patient inconvenience, and cost implications.

OBJECTIVES

This study investigated the prevalence and causes of image repeat in conventional radiography performed within mobile clinics in the Philippines.

METHODS

A retrospective review analyzed data from five mobile clinics located in two highly urbanized cities in the Philippines from July to December 2023). Radiology staff assessed image quality, with suboptimal images requiring retakes. Reasons for rejection were categorized.

RESULTS

Out of 871 radiographs taken, 118 (13.55%) were repeated. Vertebrae and pelvic girdle images had the highest repeat rates (33.33%). Positioning errors were the most common cause (44.07%), followed by underexposure and overexposure.

CONCLUSION

This study identified a concerning repeat rate (13.55%) for mobile X-rays, primarily due to improper patient positioning, particularly for specific body parts. Targeted training programs and stricter protocols for mobile clinic staff are needed. Radiography education should also emphasize these skills, potentially through collaboration with mobile clinic operators to ensure graduates are prepared for the unique challenges of this environment.

Mobile Health Units ; Patient Positioning ; Radiography ; X-rays ; X-ray Film

BACKGROUND: Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) poses distinct clinical challenges due to extensively drug resistant (XDR) phenotype, and sequence type (ST) 11 is the most dominant blaKPC-2-bearing CP-Kp clone in China. The purpose of this current retrospective study was to explore the genetic factors associated with the success of XDR CP-Kp ST11 strains circulated in the intensive care unit (ICU) of a Chinese tertiary hospital. METHODS: Six ST11 XDR CP-Kp strains were identified between May and December 2014 and validated by minimum inhibitory concentration examination, polymerase chain reaction, and pyrosequencing. The six ST11 XDR CP-Kp, as well as three multi-drug resistant (MDR) and four susceptible strains, were sequenced using single-molecule real-time method. Comprehensively structural and functional analysis based on comparative genomics was performed to identify genomic characteristics of the XDR ST11 CP-Kp strains. RESULTS: We found that ST11 XDR blaKPC-2-bearing CP-Kp strains isolated from inpatients spread in the ICU of the hospital. Functionally, genes associated with information storage and processing of the ST11 XDR CP-Kp strains were more abundant than those of MDR and susceptible strains, especially genes correlative with mobile genetic elements (MGEs) such as transposons and prophages. Structurally, eleven large-scale genetic regions taken for the unique genome in these ST11 XDR CP-Kp strains were identified as MGEs including transposons, integrons, prophages, genomic islands, and integrative and conjugative elements. Three of them were located on plasmids and eight on chromosomes; five of them were with antimicrobial resistance genes and eight with adaptation associated genes. Notably, a new blaKPC-2-bearing ΔΔTn1721-blaKPC-2 transposon, probably transposed and truncated from ΔTn1721-blaKPC-2 by IS903D and ISKpn8, was identified in all six ST11 XDR CP-Kp strains. CONCLUSION Our findings suggested that together with clonal spread, MGEs identified uniquely in the ST11 XDR CP-Kp strains might contribute to their formidable adaptability, which facilitated their widespread dissemination in hospital.
Anti-Bacterial Agents ; Bacterial Proteins ; China ; Electrophoresis, Gel, Pulsed-Field ; Hospitals ; Humans ; Klebsiella Infections/drug therapy* ; Klebsiella pneumoniae/genetics* ; Microbial Sensitivity Tests ; Multilocus Sequence Typing ; Pharmaceutical Preparations ; Retrospective Studies ; beta-Lactamases/genetics*

Clostridium perfringens causes diarrhea and other diseases in animals and humans. We investigated the prevalence, toxin gene profiles, and antibiotic resistance of C. perfringens isolated from diarrheic dogs (DD) and non-diarrheic dogs (ND) in two animal hospitals in Seoul, Korea. Fecal samples were collected from clinically DD (n = 49) and ND (n = 34). C. perfringens was isolated from 31 of 49 DD (63.3%) and 21 of 34 ND dogs (61.8%). All C. perfringens strains were positive for the α toxin gene, but not for the β, ε, or ι toxin genes; therefore, all strains were identified as type A C. perfringens. All isolates were cpe-negative, whereas the β2 toxin gene was identified in 83.9% and 61.9% of isolates from DD and ND, respectively. Most isolates were susceptible to ampicillin (94%), chloramphenicol (92%), metronidazole (100%), moxifloxacin (96%), and imipenem (100%). However, 25.0% and 21.2% of isolates were resistant to tetracycline and clindamycin, respectively. Molecular subtyping of the isolated strains was performed by using pulsed-field gel electrophoresis. Fifty-two isolates were classified into 48 pulsotypes based on more than 90% similarity of banding patterns. No notable differences were observed among the isolates from DD and ND.
Ampicillin ; Animals ; Bacterial Toxins ; Chloramphenicol ; Clindamycin ; Clostridium perfringens ; Clostridium ; Diarrhea ; Dogs ; Drug Resistance ; Drug Resistance, Microbial ; Electrophoresis, Gel, Pulsed-Field ; Hospitals, Animal ; Humans ; Imipenem ; Korea ; Metronidazole ; Prevalence ; Seoul ; Tetracycline

OBJECTIVES: This study developed a diabetes self-management mobile application based on the information-motivation-behavioral skills (IMB) model, evidence extracted from clinical practice guidelines, and requirements identified through focus group interviews (FGIs) with diabetes patients. METHODS: We developed a diabetes self-management (DSM) app in accordance with the following four stages of the system development life cycle. The functional and knowledge requirements of the users were extracted through FGIs with 19 diabetes patients. A system diagram, data models, a database, an algorithm, screens, and menus were designed. An Android app and server with an SSL protocol were developed. The DSM app algorithm and heuristics, as well as the usability of the DSM app were evaluated, and then the DSM app was modified based on heuristics and usability evaluation. RESULTS: A total of 11 requirement themes were identified through the FGIs. Sixteen functions and 49 knowledge rules were extracted. The system diagram consisted of a client part and server part, 78 data models, a database with 10 tables, an algorithm, and a menu structure with 6 main menus, and 40 user screens were developed. The DSM app was Android version 4.4 or higher for Bluetooth connectivity. The proficiency and efficiency scores of the algorithm were 90.96% and 92.39%, respectively. Fifteen issues were revealed through the heuristic evaluation, and the app was modified to address three of these issues. It was also modified to address five comments received by the researchers through the usability evaluation. CONCLUSIONS: The DSM app was developed based on behavioral change theory through IMB models. It was designed to be evidence-based, user-centered, and effective. It remains necessary to fully evaluate the effect of the DSM app on the DSM behavior changes of diabetes patients.
Blood Glucose Self-Monitoring ; Diabetes Mellitus ; Focus Groups ; Heuristics ; Humans ; Life Cycle Stages ; Methyltestosterone ; Mobile Applications* ; Mobile Health Units ; Self Care* ; Telemedicine

Voiding dysfunction is a common disease that contributes to a lower quality of life and has an increased prevalence in the elderly population. Noninvasive and objective methods such as uroflowmetry (UFM) and voiding diaries (VDs) are essential for exact diagnosis and effective treatment of this condition because patients with different causes of voiding dysfunction can complain of the same lower urinary tract symptoms. Further, different treatment options can be determined based on the diagnosis made from these symptoms. In order to improve the quality of UFM and VDs and to provide a convenient testing environment, several advances have been made by previous investigators. In this study, we investigate the history and technological mechanisms of UFM and VDs. We also aim to review UFM from the viewpoint of clinical and at-home uses, including the recently proposed toilet-shaped UFM and electronic VDs.
Aged ; Diagnosis ; Humans ; Lower Urinary Tract Symptoms ; Mobile Health Units ; Monitoring, Ambulatory ; Prevalence ; Quality of Life ; Research Personnel

Through the Declaration of Montevideo in 2011, the World Medical Association suggested that doctors worldwide should be trained in basic disaster response regardless of their specialty. The Haiti earthquake in 2010, which had the highest number of foreign medical team dispatched from all over the world, proved that untrained and disorganized team only brought confusion. This event led the World Health Organization to develop the ‘Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters ’ in 2013. This guideline will become the standard for organizing an international emergency medical team. We should be able to provide high standard of care through field hospital set up and continuous training of disaster medicine specialists.
Disaster Medicine* ; Disasters* ; Earthquakes ; Emergencies* ; Haiti ; Mobile Health Units ; Specialization ; Standard of Care ; World Health Organization

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) are important pathogens causing nosocomial infections in Korean hospitals. This study aimed to investigate the epidemiological and genetic diversity of clinical S. aureus isolates in healthcare settings from 2001 to 2008. METHODS: Samples and data were obtained from 986 individuals as part of the National Antimicrobial Surveillance Project, involving 10 regions nationwide. Molecular typing studies, including multilocus sequence typing (MLST) and staphylococcal cassette chromosome mec (SCCmec) typing were performed, and a representative clone of Korean MRSA was classified by combinational grouping using a DiversiLab (DL; bioMérieux, France) repetitive element polymerase chain reaction (rep-PCR) system. RESULTS: Nine Korean MRSA clones (KMRSA-1 to -9) were identified by analysis of genetic backgrounds and molecular characteristics. KMRSA-1 to -3, expressing clonal complex (CC) 5 (carrying SCCmec II), CC8 (carrying SCCmec III), and CC72 (carrying SCCmec IV) were spread nationwide. In contrast, KMRSA-6 was highly prevalent in Gyeongsangnam-do, and KMRSA-4 was highly prevalent in Jeollanam-do and Jeollabuk-do. CONCLUSIONS: Epidemic KMRSA clones were genetically similar to major clones identified from the USA, with the exception of KMRSA-2, which had the SCCmec III type. Our results provide important insights into the distribution and molecular genetics of MRSA strains in Korea and may aid in the monitoring of MRSA spread throughout the country.
Bacterial Proteins/genetics ; DNA, Bacterial/genetics/metabolism ; Electrophoresis, Gel, Pulsed-Field ; Hospitals ; Humans ; Methicillin-Resistant Staphylococcus aureus/*genetics/isolation & purification ; Multilocus Sequence Typing ; Multiplex Polymerase Chain Reaction ; Prevalence ; Republic of Korea/epidemiology ; Staphylococcal Infections/diagnosis/*epidemiology/microbiology

BACKGROUND: The emergence of carbapenemase-producing Enterobacteriaceae (CPE) represents a major clinical problem because these bacteria are resistant to most antibiotics. CPE remain relatively uncommon in Korea. We report the prevalence, clinical characteristics, and molecular epidemiology of CPE isolates collected from five university hospitals in Korea. METHODS: Between January and December 2015, 393 non-duplicated isolates that were nonsusceptible to ertapenem were analyzed. Production of carbapenemase, extended-spectrum β-lactamase, and AmpC β-lactamase was determined by genotypic tests. Antimicrobial susceptibility profiles were determined by using an Etest. Clonality of Klebsiella pneumoniae carbapenemase (KPC)-2-producing and oxacillinase (OXA)-232-producing Klebsiella pneumoniae isolates was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Of the 393 isolates tested, 79 (20.1%) were CPE. Of these 79 isolates, 47 (59.5%) harbored the bla(OXA-232) gene while the remaining isolates carried genes bla(KPC-2) (n=27), bla(IMP-1) (n=4), and bla(NDM-1) (n=1). Among the 24 KPC-2 K. pneumoniae isolates from hospital B, 100% were resistant to carbapenems, 8% to colistin, and 0% to tigecycline. Among the 45 OXA-232 K. pneumoniae at hospital C, 95% were resistant to ertapenem, 68% to imipenem, 95% to meropenem, 10% to colistin, and 24% to tigecycline. PFGE analysis revealed a unique pattern for KPC-2 K. pneumoniae and identified 30 isolates belonging to the dominant pulsotypes (PT)1 and PT2 among 41 OXA-232 K. pneumoniae isolates. CONCLUSIONS: CPE strains are present in Korea, with the majority of K. pneumoniae isolates producing OXA-232 and KPC-2. The prevalence and predominant genotypes of CPE show hospital-specific differences.
Aged ; Anti-Bacterial Agents/pharmacology ; Bacterial Proteins/*genetics/metabolism ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae/drug effects/*enzymology/isolation & purification ; Enterobacteriaceae Infections/diagnosis/epidemiology/*microbiology ; Female ; Genotype ; Hospitals ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; beta-Lactamases/*genetics/metabolism

BACKGROUNDKlebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bacteria, which cause serious disease outbreaks worldwide, was rarely detected in Xiangya Hospital, prior to an outbreak that occurred from August 4, 2014, to March 17, 2015. The aim of this study was to analyze the epidemiology and molecular characteristics of the K. pneumoniae strains isolated during the outbreak.

METHODSNonduplicate carbapenem-resistant K. pneumoniae isolates were screened for blaKPC-2and multiple other resistance determinants using polymerase chain reaction. Subsequent studies included pulsed-field gel electrophoresis (PFGE), multilocus sequence typing, analysis of plasmids, and genetic organization of blaKPC-2locus.

RESULTSSeventeen blaKPC-2-positive K. pneumoniae were identified. A wide range of resistant determinants was detected. Most isolates (88.2%) coharbored blaKPC-2and rmtB in addition to other resistance genes, including blaSHV-1, blaTEM-1, and aac(3)-IIa. The blaKPC-2and rmtB genes were located on the conjugative IncFIB-type plasmid. Genetic organization of blaKPC-2locusin most strains was consistent with that of the plasmid pKP048. Four types (A1, A2, A3, and B) were detected by PFGE, and Type A1, an ST11, was the predominant PFGE type. A novel K. pneumoniae sequence type (ST1883) related to ST11 was discovered.

CONCLUSIONSThese isolates in our study appeared to be clonal and ST11 K. pneumoniae was the predominant clone attributed to the outbreak. Coharbing of blaKPC-2and rmtB, which were located on a transferable plasmid, in clinical K. pneumoniae isolates may lead to the emergence of a new pattern of drug resistance.

Anti-Bacterial Agents ; pharmacology ; Bacterial Proteins ; metabolism ; China ; Electrophoresis, Gel, Pulsed-Field ; Hospitals, Teaching ; Klebsiella Infections ; etiology ; Klebsiella pneumoniae ; drug effects ; metabolism ; Methyltransferases ; metabolism ; Microbial Sensitivity Tests ; Multilocus Sequence Typing ; beta-Lactamases ; metabolism