Issue link: https://maltatoday.uberflip.com/i/1004621
NEWS 6 maltatoday | SUNDAY • 15 JULY 2018 JAMES DEBONO NEARLY three out of four X-rays per- formed at the Mater Dei Hospital's emergency department for ankle inju- ries could have been performed unnec- essarily, as no fracture was found, an audit published in the Malta Medical School Gazette shows. Out of the 323 patients for whom their physician requested an ankle or ankle- foot X-ray at the Mater Dei A&E be- tween September and December 2015, 76.4% did not have any fractures. The authors recommended the imple- mentation of a standard protocol of care for ankle injuries based on the Ottawa Ankle Rules. This protocol states that an X-ray is required only in patients who have an acute knee injury with one or more of the following conditions: when the pa- tient is over 55, when there is tenderness at head of fibula, when there is isolated tenderness of patella, when patient is unable to flex the knee more than 90°, and when the patient is unable to bear weight both immediately and in the emergency department. The study warns that the use of ionis- ing radiation found in X-rays, even if in small doses, may predispose to an in- creased risk of developing a malignant tumour. The authors said physicians tend to use X-rays in order to confirm their diagno- sis especially when they need to rule out the presence of a fracture. The study concludes that the use of guidelines can reduce inappropriate ra- diography usage, through appropriately filled-in request forms to establish bet- ter communication between the physi- cian and the radiologist. Sarah Cuschieri from the Anatomy Department, Stephan Grech from the Royal National Orthopaedic hospital in London and occupational therapist Jan- ice Abela authored the study. Chest X-rays on infants can be avoided Another study also found that 53 out of 81 chest X-rays performed on children reporting symptoms of bronchiolitis could have been avoided. The study cites "parental requests and anxiety" as one of the main reasons for an over-reliance on X-rays in the treat- ment of this disease. Bronchiolitis is the most common dis- ease of the lower respiratory tract dur- ing the first year of life and one of the most common medical emergencies in infancy. Pediatricians Sarah Anne Caruana Galizia, Veronica Said Pullicino and Cecil Vella warned that chest X-rays should not be taken indiscriminately as they carry a small but significant expo- sure to radiation and are rarely useful in the diagnosis. A single chest X-ray film contains the equivalent of three days of natural back- ground radiation. All patients aged less than six months attending the Pediatric A&E between January to April 2016 and October 2016 to February 2017, with bronchiolitis, were included in the audit. Of the 148 infants included in this study 81 (54.7%) had a chest X-ray per- formed. Only 28 (34.6%) of the chest X-rays were indicated according to the guidelines issued National Institute for Health and Care Excellence (NICE) of the United Kingdom and the American Academy of Pediatrics (AAP). Chest X-rays may be useful in detect- ing pneumonia. But 82.7% of the chest X-rays performed for infants presenting symptoms of bronchiolitis, were report- ed as normal or as showing peribron- chial cuffing. Six cases where X-rays were conducted despite not fulfilling criteria established in international guidelines, showed signs Audits find unnecessary use of X-rays The study cites 'parental requests and anxiety' as one of the main reasons for an over-reliance on X-rays in the treatment of this disease Doctors say the use of X-rays for ankle fractures but also for chest infections in children has to be curtailed MATTHEW VELLA A court decision in a defama- tion case against The Times of Malta has suggested that pri- vate individuals could enjoy protection from the prying eyes of the media – unless they have willingly submitted themselves to the public arena. The decision was handed down by Magistrate Francesco Depasquale in the defamation case opened by Labour minister Helena Dalli and her husband Patrick, in a complaint on re- ports that they had carried out irregular works on a property they were about to sell to a third party through their company Pada Builders. The court declared that the newspaper was incorrect in its reporting, because it ignored declarations by buyer Jason De- sira early on in the saga, that he was carrying out repair works after having been granted per- mission to do so, following a promise-of-sale agreement. But Magistrate Depasquale went further to declare that pri- vate persons cannot be subject to scrutiny unless they have en- tered the public arena "by way of involvement in matters that are in themselves public." The reasons for the magis- trate's observation do not ap- pear fundamental in the reason he found The Times and its for- mer journalist, Caroline Mus- cat, guilty of defamation, name- ly for persisting in an incorrect rendition of the facts. Depasquale, however, said that throughout the course of the Times's reports, Patrick Dalli had suffered the refusal of a planning permit on the Zejtun property ostensibly – always by Dalli's own claim to the plan- ning appeals tribunal – because his case was sullied by media exposure. The appeals tribunal overturned the refusal, without going into the merits of the al- leged media effect. To this, Depasquale chimed in with a strong view on the privacy of spouses of PEPs (po- litically exposed persons): "The spouse of a government min- ister does not get to be treated the same way as a politician and with the same fastidious scruti- ny – the fact that his wife chose this career cannot be treated as a condemnation for which his affairs be subjected to scrutiny and exposed in public… the courts must protect private citi- zens whose only 'guilt' is to be married to people in politics." Depasquale went further, calling time on the tactic of Political spouses score a point for their right to privacy A private affair: Patrick Dalli (centre) can expect a higher degree of privacy than his politician wife Helena (right), although the same cannot be said of the Prime Minister's spouse, Michelle Muscat, (left) who uses her public persona for philantropic purposes