bluuebunny/crossref_metadata_2025 huggingface dataset:
Refracting experience: Reflection, postmodernity and transformations
Authors: Pryce Anthony
Published: March 2006

'Reflection' might be characterised as a process that uses a number of relatively simple models for analysis of occupational practice. Such models structure ways of focusing on cause, effect and affect. On the other hand, the rhetoric of professional and personal empowerment is grounded in the language of reflexivity, self-knowledge, humanistic psychology and (postmodern) constructions of spirituality and the sacred. However, nursing literature appears rarely to address the postmodern, cultural contexts of reflection.

This paper identifies paradoxes at the heart of reflective practice in nursing and some of the ideological functions of reflection. It focuses on the tensions central to reflection, some of which have the potential to highlight contradictions in practice, research and the production of theory. The aim here is to consider modernist assumptions that have framed nursing and nursing research while often failing to interrogate and explicate its own inherent contradictions. It is argued that a more critical reflexive process grounded in social context is potentially transformative through engaging with the postmodern destabilising of normative assumptions. This is considered in relation to modernity and postmodernity and the increasing emphasis on text and intertextuality.

In conclusion, it is proposed that refraction might be a helpful concept. It is suggested that through a more sociologically prismatic lens, the realities and truths of the reflective narrative can be interpreted as a transformative means of resistance to the dominant medicalised discourses.
Moving towards a special kind of care for people with dementia living in care homes
Authors: Bruce Errollyn , Surr Claire , Tibbs Margaret Anne , Downs Maurna
Published: March 2006

This paper considers the position of people with dementia in care homes, and the different understandings of their predicament. There are conflicting pressures on care homes. On the one hand there are reasons to ignore dementia, but on the other there are new expectations that a reasonable quality of life is both possible and desirable for people with dementia. These expectations are informed by a view of dementia which challenges narrow medical understandings and implies a kind of care that is based on sensitive interpretations of individuals, and is able to meet a broad range of needs.

Drawing upon findings from a study of wellbeing among people with dementia in long-term care, the paper suggests that applying new understandings to care practice is a slow but worthwhile process. In a favourable care environment, people with dementia can maintain wellbeing, although staff need continuing encouragement and support, especially when residents' needs are complex. In their own way, people with dementia make efforts to hold on to the essential underpinnings of wellbeing, and these efforts need to be recognised and supported. Staff who develop a special understanding of the lived experience of dementia, together with skills to support broader needs, can make a significant difference to residents' lives. The challenge for care homes is to find ways of enabling staff to work in this way.
Raising the profile of nursing research among medical research charities
Authors: Crofts Linda , Mcmahon Ann
Published: March 2006

The nursing professions' R&D priority-setting Initiative was established to increase the involvement of nurses, midwives and health visitors in research and development activities in the UK. A first phase of work explored the feasibility of establishing a systematic and coordinated process for identifying priorities for R&D for the nursing professions.

The second phase aims to build on the collaboration and cooperation achieved in phase one to establish a process and structure to promote a united professional voice for nursing on R&D (Scott et al., 1999). To this end, proposals were developed to establish a strategic alliance of the professional interests which would be known as the Strategic Alliance for Research in Nursing, Midwifery and Health Visiting. Part of the role of this alliance would be to lobby for funding for research activity in nursing.

This paper sets out to investigate the involvement of nurses with the nursing research charities and looks at ways nurses could improve their chances of obtaining funding from such sources.
Research governance-the challenge
Authors: Clifford Collette
Published: March 2006

This paper explores some aspects of managing research in healthcare practice today. The work is based largely on government guidelines in England in which a research governance framework has been developed and is now being used to monitor many aspects of research activity in the NHS. Following a brief overview of the evolution of the research governance framework, some aspects of the strategy are outlined and considered. The challenge to nurses is to ensure that research work is developed in accordance with these guidelines, which lay specific expectations on people and organisations working in health-care research
Researching mental health: Pathology in a postmodern world
Authors: Freshwater Dawn
Published: March 2006

The invention of madness led to the professional practice of mental health that has as its main aims the identification and treatment of mental illness. Traditionally, notions of madness and sanity are polarised, with sanity being linked to functionality and madness being aligned with dysfunction. While such a dichotomy is always questionable, currrent studies of mental illness reflect the social dissolution of such stark categorization. Indeed, it could be argued that this divergence is sensible, given that behaviours which might typically be described as indicators of mental illness could be considered as reasonable protective mechanisms.

Contemporary approaches to researching mental health problems focus on the 'madness of the other', with little attention being paid to the madness of research itself or, indeed, to the researcher's own madness. This paper argues that paying attention to the madness of those producing mental health research in the academy (or is it the asylum?) may offer insight into the devolution of madness. Further exploration in this direction may show how the research process itself could be facilitated and enriched by the rehabilitation of such madness.
Mental health nurse prescribing: The research challenge
Authors: Gournay Kevin , Gray Richard
Published: March 2006

Nurse prescribing is gradually being implemented across a range of areas in healthcare. This paper examines the context of prescribing for mental health problems and discusses the issues relating to nursing and some of the broader matters such as the effectiveness of medication for mental health problems, the economics of mental illness and more general workforce issues. Mental health nurse prescribing obviously presents some significant research opportunities that should be seen within the settings of the Medical Research Council's framework for assessing complex health interventions (Campbell et al., 2000). The paper also considers some of the challenges of undertaking a randomised controlled trial for a topic within what Nancy Woolf (2000) describes as a 'socially complex service context'. Such a context requires the research team to consider a number of potential confounds. The paper concludes by suggesting some ways that such sources of confound be minimised.
Young people with Parkinson's disease: Report of a pilot study to identify the research issues and approaches to data collection
Authors: Fontenla Marina , Gould Dinah
Published: March 2006

Parkinson's disease (Pd) affects over 120,000 people in the UK. Onset usually begins in people over 50 but in a significant number of people symptoms first develop at a much earlier age without affecting life expectancy. A pilot study to explore quality of life, psychological adjustment and service use for this population initially foundered because of difficulties in contacting a sample of younger people with Pd and motivating them to participate. The pilot study was then extended to determine these people's perceptions of their condition and their needs through content analysis of a magazine circulated by their user group, and a website. Information was also sought from key informants working with young people with Pd. This eventually resulted in contact with the target sample and the collection of valuable data through participation in a conference held by the user group. Reasons for reluctance to become involved in traditional research studies related to denial of having Pd; a desire to conceal it from others, and tiredness associated with Pd, resulting in the need to prioritise activities.

This unorthodox piloting proved invaluable in refining the original study questions and identifying more effective approaches to data collection and sampling. The experience of undertaking the pilot study may be of wider interest because it indicated that despite NHS reforms focusing on the user perspective, some health consumers were not enthusiastic about participating in research or informing government policy. The importance of thorough pilot work to the success of the eventual investigation is also demonstrated.
Workforce and workload: Are nursing resources used effectively?
Authors: Jenkins-Clarke Susan , Carr-Hill Roy
Published: March 2006

This paper describes key findings and implications from analyses of activity and workload of nurses of different grades and support workers based on data collected using Nursing Information Systems for Change Management (NISCM). 'Activity' refers to the amount of time on a shift spent on different tasks, and 'workload' refers to the number of patients in a variety of wards by demand/dependency group. The activity evidence is based on data from 5,208 staff recording their activity in 535 shift blocks in 19 hospitals and the workload evidence is based on data from 38,585 shifts across 90 wards in 17 hospitals.

Four of the seven main findings have been selected for presentation here: variations, division of labour, skill-mix issues and flexibility. The findings show that there appears to be substantial systematic variation between hospitals in the grade mix of nursing staff and that there is little difference in the types of task undertaken by different grades of staff. As overall staffing increases, there is little increased specialization between staff groups and little flexibility in the deployment of nursing staff according to patient demand.

The overall aim of the paper is to promote discussion relating to the development of appropriate and relevant strategies for changing skill-mixes in hospitals.
Turnover rate in nursing and midwifery: The Irish experience
Authors: McCarthy Geraldine , Tyrrell Mark P. , Lehane Elaine
Published: March 2006

It became apparent in 1998 that there was a significant shortage of nurses and midwives in the Republic of Ireland. Because of the lack of data on the reasons for this, a national study was commissioned to estimate the turnover rate among registered nurses and to identify the underlying reasons for the loss of so many trained staff to the profession. Both quantitative and qualitative methodologies were used. Participants were drawn from 128 health service agencies, and 1,921 questionnaires were completed over a one-year period by nurses and midwives leaving the service. Telephone interviews were also conducted with 140 participants. The results indicate a mean turnover rate of 12%, with considerable variations across services. Reasons for leaving included wanting to pursue other employment in nursing (35%), travel abroad (21%) and a desire to undertake further study (12%). It appeared that a considerable number of nurses would have been retained if retention strategies focusing on promotion of greater autonomy, professional development, managerial support, or improved professional practice environments had been introduced.
The emergence of professional doctorates in nursing in the UK: Where are we now?
Authors: Galvin Kathleen , Carr Eloise
Published: March 2006

This study explored the views of course leaders and students taking doctorates in nursing science. Semi-structured telephone interviews were undertaken with a purposive sample of course leaders and students (n=8) from three UK courses running at the time of the study. One course had been established for six years, the other two were in the first year of delivery.

The theme we have labelled 'new knowledge for improvement' describes what emerged from the data as the underlying mission and philosophy guiding the doctorates.

Students were found to value the following course features: supportive systems; peer group support; being embedded in an academic department; exposure to multiple research methods; and preparation for clinically focused research. Some nurses were not attracted to what they perceived as a long and lonely route to a PhD, favouring instead the new-style doctorates because of the supportive networks these offer. While the focus of this paper is nursing, there is a long history of professional doctorates in other fields. This paper outlines the developments in professional doctorates and offers a definition and some differentiation between the new-style doctorate and the traditional PhD.

The major themes that emerged from the data concerned problems in professional nursing doctorates, such as the inherent high volume of work; lack of opportunity to use skills in practice; for some students, the uni-disciplinary nature of the courses; negative views of 'taught' doctorates; issues about doctoral standards, and the credibility of the award title in the outside world. Questions and problems for future delivery of doctoral education are outlined.
Capacity-building and careers in nursing research: Rationale and context
Authors: Bishop Veronica , Freshwater Dawn
Published: March 2006

This paper aims to review and provide a brief critique of the modern health service in the UK, highlighting the need for nursing to develop a genuine culture of research that can enable the profession to deliver research-oriented practice. The need to develop careers in nursing in order to provide evidence-based practice and appropriate care to patients is discussed within the context of current policy drives and professional aspirations. It is argued that not only will this raise the overall standard of care, but also will develop the level of professional knowledge, credibility and accountability of practitioners. Links between research, clinical governance and evidence-based practice are made, and the wider implications for the position of nursing within healthcare services are discussed.
Practitioner research: Exploring issues in relation to research capacity-building
Authors: Meyer Julienne , Johnson Barbara , Procter Susan , Bryar Rostamund , Rozmovits Linda
Published: March 2006

Lack of funding for research capacity-building in nursing and allied health research has been a long-standing issue (Rafferty et al., 2002; Scott, 2002). More recently, limited moneys have been made available in the form of doctoral and post-doctoral awards from the Health Foundation and the Department of Health, largely to prepare nurses and allied health professionals for a career in research. However, little attention has been given to the capacity-building required for practitioners who may now have research as a core component of their work: nurse consultants and research and development nurses working in NHS and primary care trusts, for example. These practitioner researchers tend not to have previously benefited from the luxury of full-time funding and have learnt their research skills through higher education courses — Master's or part-time PhDs — or 'on the job' experience.

This paper reports findings of a three-year study, the CELEC [Central and East London Education Consortium (now the North East London Workforce development Confederation)] Action Research Project: Care for Older People, that focused on the development and evaluation of seven lead R&D nurses: Care for Older People. These posts were appointed at Whitley Council (Nurse) Grade I or Research and Analogous Staff Grade II, depending on whether the lead R&D nurses preferred their contract to be with the NHS or the university. It was anticipated that the project might prepare some practitioners for a future role as nurse consultants. The paper reflects on the lessons learnt from this project, in particular the lead R&D nurses' education and support needs. Although findings mainly relate to their work as action researchers, they are likely to be of wide interest given that nurse consultants are expected to engage in this form of practice development.

Action research is concerned with improving practice. It seeks to do research with and for people, rather than research on them (Meyer, 2000). It is thus ideally suited for practitioners who may, in addition to their role in research, also have responsibility for developing services. The findings may also be of interest to lecturer practitioners, who might choose to use action research as a means of facilitating work-based learning.
Research capacity and output in paediatric nursing
Authors: Frank Linda S.
Published: March 2006

There is general agreement that nursing-led research is under-resourced with respect to funding for academic preparation and for the conduct of clinical research. All of the previous literature, however, focuses on the nursing profession as a whole and provides little insight into the capacity and resource issues for specialty practice areas such as children's nursing. This paper provides an overview of the state of paediatric nurse-led research capability, capacity and output within the limitations of the available data. The findings reveal that paediatric nursing in the UK currently has very limited capacity to conduct and utilise research in the care of children and is in a weak position to create a future workforce that has this capacity. Nurse-led research on children's health issues is urgently needed if the UK paediatric nursing workforce is to deliver the standard of care specified in the Children's National Service Framework. However, strategies for accelerating the development of research capacity and output within paediatric nursing all require targeted financial investment to build capacity. This analysis is illustrative of the need for a more detailed investigation of nursing research capacity by specialty. Key messages and action points are suggested for nurses in higher education, professional nursing organizations, doctorally prepared nurses and their employers.
Politics or paranoia: Reading between the lines when undertaking social research studies
Authors: Taylor Julie , Cantrell Jane
Published: March 2006

Although reports of political issues in social research were popular in the 1960s and 1970s, more recent accounts of nursing research largely neglect this area. This paper highlights such political issues, offering guidance to help equip researchers to deal with these.

Published reports of research studies necessarily present a linear account of how, and how well, the research question was answered. It is rare for research to follow so straightforward a path, because interwoven is a little discussed, but not uncommon, political arena. Standard texts offer plenty of guidance on research ethics, but there is little advice to help researchers walking a thin line between diverse political elements. This paper draws on the literature and provides examples from the authors' research to illustrate some of the key political scenarios researchers may face. The advantages and disadvantages of insider/outsider status are discussed in order to present a 'matrix of involvement' to illustrate key issues. It is suggested that as the pressure to undertake funded research rises there is likely to be an exponential increase in the complex political environments in which research takes place. This paper offers some pointers towards reading between the political lines and navigating research successfully towards a conclusion.
Researching patients in the vegetative state: Difficulties of studying this patient group
Authors: Geluing Leslie
Published: March 2006

It is now generally accepted that all patient groups should benefit from the potential advances in knowledge and understanding that result from clinical research. Despite this principle, patients in the vegetative state remain a group that has been chronically under-researched by neuroscientists because complex ethical questions and logistical dilemmas are raised by such research.

The vegetative state is one of the best known but least understood of neurological conditions. It affects a small but significant number of people who make a poor recovery after sustaining a brain injury and has been brought to public attention through high profile cases in the UK and the USA. This paper defines the vegetative state and explores four important issues that should be considered when planning clinical research in this field. It is demonstrated that not only is it possible to undertake such research but also that there needs to be more of it so that greater numbers of patients and their families will benefit.
The extended role of the clinical research nurse: Building an evidence base for practice
Authors: Stephens-Lloyd Amanda
Published: March 2006

Increasing numbers of nurses are moving from their direct clinical base to take up posts as clinical research nurses. However, although there are published guidelines about their role responsibilities, little is written about the reality of the role. This paper offers an experiential account into the variety of responsibilities undertaken by CRNs, highlighting the extended role that experienced CRNs may undertake, the transferable skills exhibited and the extent to which traditional boundaries between professionals can continue to be challenged. Role remits are examined in an attempt to show that not only do CRNs possess many of the skills that are highly regarded and respected in specialised clinical nursing but also that they may be well placed within the profession to assist in building the evidence base for practice as nursing continues to develop.
Seconding health care assistants to a pre-registration nursing course: Evaluation of a novel scheme
Authors: Gould Dinah , Carr Graham , Kelly Daniel , Brown Pauline
Published: March 2006

Traditionally in the United Kingdom, reliance has been placed on unqualified support workers, such as student nurses, to deliver a high proportion of patient care. However, the move of nurse education into higher education and the accompanying supernumerary status of student nurses in the 1980s resulted in a shortfall of staff to deliver that care. The government has made a number of suggestions for increasing recruitment. One possible solution regarded as very promising is to encourage health care assistants (HCAs) with at least 12 months' experience in the National Health Service to enrol on existing pre-registration programmes, providing them with financial incentives to do so. Very little literature directly concerned with training opportunities for HCAs could be traced, but it was evident that financial constraints and family commitments had, in the past, operated as disincentives to training, although some HCAs would otherwise be keen to register.

In 1999 one of the workforce development confederations in London responded to government policy by seconding HCAs onto a pre-registration programme operated by the local university. Plans for evaluation were made at the outset. Interviews were conducted with two consecutive intakes of secondees at three time intervals: after three months; after 12 months and during the final placement of the 36-month course. Interviews with other stakeholders were conducted just before the course ended. A qualitative approach was taken and the data were analysed employing the sequence recommended by Miles and Huberman (1994).

Evaluation highlighted important features of the secondment process contributing to its success and indicated pitfalls attached to introducing such schemes. It is recommended that evaluation should be extended to explore how the new staff nurses prepared by this novel scheme continue to develop their career trajectories. Given the emphasis now being placed on the 'skills escalator' model of staff development in the NHS, such approaches will assume even greater importance in future, and more extensive evaluations will be needed.
Regulating complementary medicine implications for the nursing profession
Authors: Wiliams Lorraine , Jack Pamela , Russo Hazel
Published: March 2006

In any healthcare profession, orthodox or complementary, quality of care, treatment and patient safety must be given the highest priority. The establishment of effective systems of professional regulation is seen by many as essential in order for this to happen. This paper outlines the case for improving systems of statutory and voluntary self-regulation in the complementary sector and charts the progress and current developments in a number of therapies towards that end. The impact of an independent, non-governmental organisation, The Prince of Wales's Foundation for Integrated Health, in driving forward this process, is discussed. Nurses, as part of any modern multidisciplinary healthcare team, need to be aware of the advances and current issues emerging in this sector and the increasing need for their profession to be involved in shaping future developments.
Exploring the use of complementary and alternative medicine by people with cancer
Authors: Corner Jessica , Harewood Jackie
Published: March 2006

Complementary and alternative medicine are widely used by people with cancer, yet little information exists as to how such therapies are used or people's motivations for using them, and few studies have been conducted to assess the efficacy and safety of these in the context of cancer and its treatment. Therapies may be used in parallel to conventional cancer treatment in the belief that they may help cure the cancer, prevent its recurring, help manage the symptoms or simply enhance well-being. Little data exist for patients to help guide choices over whether or not to use complementary medicine. There is also a lack of information available to inform patients as to how to use therapies for their best effect; many patients manage complementary treatments themselves as there is little else to guide them. Pressure is increasing to fill in the large evidence gaps surrounding the efficacy and safety of complementary medicine through conducting large-scale clinical trials. This paper argues against launching, at this stage, a major initiative to conduct clinical trials to test the effectiveness of various therapies; instead, an approach using qualitative methods and drawing on biographical narrative research is advocated.

We are in the process of collecting information about how people with cancer use complementary therapies in a longitudinal study of cancer patients who have declared that they are users or non-users of complementary medicine, funded by the NHS R&D Programme. Using a biographic narrative method, detailed maps of the ways in which patients' use complementary medicine and the intersection of this with individual cancer journeys and personal biographies are being acquired. Arguments for this novel methodological approach are presented.
Postoperative Hepatic Transplants
Authors: Guerra Lea M.
Published: March 2006

The role of duplex ultrasound in the hepatic transplant patient after surgery is to assess vascular compromise, limited biliary complications, and fluid collections. Debate surrounds sonography's strengths and limitations in detecting the most serious and common complication, hepatic artery thrombosis, which is key in this discussion. Sonographers should be familiar with the limitations and the exciting, new technology developing in hepatic transplant imaging to ensure quality patient care.
American Registry of Diagnostic Medical Sonographers
Authors: Williams Carol , Benson Carol B. , Rhodes Anne , Schaefer Lyn
Published: March 2006

The American Registry of Diagnostic Medical Sonographers administers certification examinations in various specialty areas. To ensure that these examinations reflect clinical practice, the American Registry of Diagnostic Medical Sonographers regularly surveys registered sonographers to determine current practice frequencies.

The Abdominal Exam Development Task Force recently conducted a task analysis survey of a random sample of 2500 registered diagnostic medical sonographers in the abdomen specialty. The abdominal examination content outline was revised to reflect changes in practice since the previous survey, which was conducted in 1987.

The most notable change is the widespread use of pulsed and color Doppler by sonographers. As a result, the examination content outline has a new section entitled “Abdominal Vasculature with Doppler.” In addition, Doppler examination items have been added to other sections of the examination. The new content outline, with the assigned percentages for each section of the examination, is included in this summary.
Evaluation of Fetal Hands With Ultrasound During a Routine Obstetric Examination
Authors: Bobodzhanov Aleksey , Kramer Dawna
Published: March 2006

In this prospective study, 100 second trimester fetuses were assessed to determine the frequency of visualization of the open fetal hands and the three phalanges of the fifth digit during a routine ultrasound examination. Open right hands were seen in 82 (82%) fetuses, and the three phalanges of the right fifth digit were seen in 71 (71%) fetuses. Open left hands were visualized in 80 (80%) fetuses, and the three phalanges of the left fifth digit were seen in 70 (70%) fetuses. Both open hands were seen in 73 (73%) fetuses, and only one open hand was seen in 17 (17%) fetuses. Fetal abnormalities, such as clenched hands with or without overriding fingers, hypoplasia of the middle phalanx of the fifth digit, or clinodactyly of the fifth finger, have been reported to be associated findings of certain fetal chromosomal disorders (e.g., trisomies 13, 18, and 21) and may initiate further genetic evaluation. The present study shows that it is feasible to include the assessment and documentation of fetal hands in the routine obstetric ultrasound examination without significantly increasing the scanning time.
Inferior Vena Caval Syndrome and the Sniff Test for Elevated Central Venous Pressure and Its Contributing Factors
Authors: Erhardt Contessa L. A.
Published: March 2006

A prospective analysis of 50 apparently healthy subjects and intensive care subjects was performed to determine the reliability of two-dimensional ultrasound in the detection of elevated central venous pressure. The sniff technique was used as a means to determine the caval index of the inferior vena cava. Twodimensional images of the inferior vena cava were obtained 3.5 cm inferior to the right atrium where caval respiratory motion and elasticity were observed. Quantitative analysis (percent inspiratory collapse) was determined by measuring the antenor-to-posterior diameter of the inferor vena cava immediately upon the subject's rapid inspiration and expiration. The sniff test of the inferior vena cava has been found to be a sensitive index of central venous pressure-that is, with either increased vena caval dilatation or central venous pressure, the percent collapse of the inferior vena cava is expected to decrease upon the subject's inspiration. Twenty-two of 50 subjects (44%) tested positive with the use of the sniff technique for elevated central venous pressure with an associated abnormality rating of 90%. The full inspiratory method was found to yield caval indices 10-20% lower than the sniff test data and may be responsible for false-positive values in normal subjects. Two-dimensional ultrasound of the inferior vena cava using the sniff technique With examination of other organs may be a reliable diagnostic modality for the detection of elevated central venous pressure and its contributing factor(s).
Carotid Body Paragangliomas
Authors: Baldwin Lisa Davidson , Stephenson Susan Raatz
Published: March 2006

Three case reports discuss similar ultrasonic appearances of carotid body tumors. Ultrasound findings include a hypoechoic mass with multidirectinal color flow located at the carotid bifurcation. The most common sign of a carotid doby tumor is a palpable painless neck mass.
Extrahepa tic Portal Vein Aneurysm
Authors: Castor Barbara K. , Dahnert Wolfgang
Published: March 2006

The following is a case report of an 80-year-old woman, who, to the authors' knowldge, is the oldest reported patient to have an extrahepatic portal vein aneurysm. As in this patient, most findings of this rare lesion are incidental. The authors made the presumptive diagnosis of a congenital etrrahepatic portal vein aneurysm based on the location, the absence of underlying lier, pancreatic, biliary duct, gall bladder disease, or any other apparent cause. Gray scale and color duplex sonography were used to make the diagnosis in this case.
Sonographic Evaluation of a Pancreatic Pseudocyst in Coniunction with Portal Vein Thrombosis and Cavernous Transformation
Authors: Bieker Teresa
Published: March 2006

Ultrasound and computed tomography are the major diagnostic imaging tools used to evaluate the pancreas. Ultrasound, however, is usually more accessible and less expensive. When pancreatitis at eudocyst is suspected, both imagin moltes can be used to make: an accuate adiagnosis.
Prenatal Diagnosis of Twin Reversed Arterial Perfusion Sequence
Authors: Messina Laurel P. , Craigo Sabrina
Published: March 2006

A case of Twin Reversed Arterial Perfusion (TRAP Sequence) is presented. This phenomenon occurs rarely in monochorionic twin pregnancies. TRAP sequence should be considered in cases where fetal "demise" is present. Ultrasound plays an important role in diagnosis of in-utero disorders affecting twin pregnancies.
A Cost Utility Analysis of Sonograhestrography Compared with Hysteroscopic Evaluation for Dysfunctional Uterine Bleeding
Authors: Evans Kevin D.
Published: March 2006

Research was conducted to discover whether the cost utility of sonohysterography was superior to hysteroscopic diagnosis for patients with dysfunctional uterine bleeding. Participants in: this study consisted of sonography patients (N = 100), who received care in a managed care setting. This correlational study covered, a 12-motnth period. Relative value units (RVU) were used from the same region to compare costs between treatments. Discounting was not done because these data were collected over the it same 1-year period. Thes time trade-off method was:Sused to obtain measures of preences for health states. Both treatment and control subjects rated their perceptions. Patients reported values an average of 0.67 (on a scale from 0 to 1 where perfect health was given a1). A chart review provided the ability to see a return to normal health. The change in health pecption rating was 0.30. Regionally, RVU csting was done and demonstrated that costs were $ 100 for sonohysterography and $217.00 forr, hysteroscope evaluation. Global cots as well as any patients' losses in revenue were considered. The rnimprvemen0t in health status was replicated and again demonstrated: worthiness of treating dysfunctional uterine bleding. Costs were compared, and it was shown that a cost saving exists for sonohysterography over hysteroscopic evaluation. For patients in this region, sonohysteroaphy had a better economic evalu4ation than hysteroscopic evaluation in treating this debilitating gynecologic condition.
The Use of Ultrasound to Identify Fetuses with Macrosoomia in Diabetic Pregnancies
Authors: Rasmussen Tracy L.
Published: March 2006

Diabetic pregnancies are associated with an increased incidence of fetal macrosomia. Prenatal detection of macrosomia is particularly important because of the potential maternal and neonatal morbidity associated with vaginal delivery. Early detection of macrosomia enables the clinician to decease the risk of morbidityeby either fprearing for complications associated with vaginal delivery or changing the timing or route of delivery. M acrosomia is suspected with an estimated faetalweight greate than or eqal to 4,000 g. Two; methods are:used to predict: fetal birth weight The first method is clinical evaluation,:which is based on abdominal palpation of fetal parts and fundatl: size. AThe second metho dis by sonogr aphic examinanon, which is based onfetal biparietal' diameter, abdominal circumferee, and femur length, which are then. plugged into a regression equation to calculat fetal: weight. Clinical techn ques do not relably predict fetal weight. Although ultrasound i's not particularly accurate at determining fetal wiht, it is more reliable than cliniali technique. Ultrasound therefore plays a major role in i;early detectio of m acrsoma. Current research valuates altering or Oexpandingthe use of ultrasound to more accurately-predict macrosomia in infants of diabetic mothers.
Contrast Echocardiography in Clinical Practice
Authors: Bierig S. Michelle , Chapman James V. , Newman Cynthia , Zuck Vincent
Published: March 2006

After FDA approval of the new-generation contrast agent Optison (Mallinckrodt Medical, St. Louis, MO) January 1998, the use of contrast in echocardiograhy has become an invaluable tool. A review of 100 patients revealed contrast to be useful for endocardial border definition and wall segment analysis, enhancement of pulsed Doppler, and chamber opacification for the detection of thrombi. Evaluation of wall segments by two observers before and after injection of the contrast agent revealed an increase in the number of wall segments visualized by 4.8. Postinjection readings were consistent between the two observers. Routine contrast echocardiography may provide a more diagnostic study.
Sonographic Evaluation of an Anembryonic Cervical Pregnancy Treated with Methotrexate
Authors: Burton Elizabeth B. Koelmel
Published: March 2006

Cervical ectopic pregnancies are rare, but they can pose a serious threat to the future fertility of a patient. Previously, the only available mode of treatment was dilatation and curettage, which often led to uncontrolled bleeding and hysterectomy. In the last decade, the treatment of ectopic pregnancy with methotrexate has proven to be an effective therapy and enables the preservation of future fertility. We describe the sonographic features and evolution of an anembryonic cervical pregnancy treated with an intramuscular methotrexate injection.
Sociopolitical Symposium
Authors: Price Susan McLaughlin
Published: March 2006

The issue of nonsonographers performing ultrasound exams is an extremely controversial subject within our field. The matter should not be just concerned with protecting turf, but should allow for the most effective manner of healthcare for patients. This article is not meant to endorse the practice of ultrasound education, it is meant to address the need for ultrasound education among emergency medicine physicians who are legitimately performing ultrasound exams.
Testis Conservation in the Setting of Intratesticular Tumor
Authors: Meacham Randall B. , Childs Stacy J.
Published: March 2006

Treatment for a testicular tumor is commonly a radical orchiectomy. In men with only one functioning testis, this results in loss of fertility. This can be disheartening to the patient and surgeon when the tumor turns out to be benign. We present a case where intraoperative ultrasound was used to localize a benign intratesticular tumor, allowing for the remaining testicular tissue to be preserved.
Ultrasound Diagnosis of a Common Carotid Artery Pseudoaneurysm
Authors: Scalf Thomas C. , Drose Julia A.
Published: March 2006

Pseudoaneurysms of the femoral artery occur frequently, often as a postinterventional complication.1 Iatrogenically induced pseudoaneurysms of the common carotid artery are less frequent. We report a case of a pseudoaneurysm of the common carotid artery that occurred following attempted placement of an internal jugular line.
Sonographic Diagnosis of Exencephaly
Authors: Best Carolyn D.
Published: March 2006

A case of exencephaly is presented. Rarely imaged, exencephaly is the second stage in the development:: of f clinically aparent anencephaly inahumans. The bibed appearance of the brami tissue has been idesribed as a "Mickey, Mouse Head."1 Since this is a lethal malformation, early deton is critical for initiationof appropriate supportvandtcounseling systems.
The Role of Ultrasound in Assessing Arterial Dissection: Location and Extension
Authors: Johnson Teresa M.
Published: March 2006

Arterial dissections are life-threatening occurrences. Ultrasound is useful in identifying the presence of a dissection and evaluating its extent. Presented is a case of and extensive arterial dissecton extending from the carotid arteries througy the iliac arteries.
The Influences of Ultrasound Stimulated Paternal Fetal Bonding and Gender Identification
Authors: Freeman Anita
Published: March 2006

This study evaluated the significance of the ultrasound examination during the second trimester as a visual aid in stimulating the bonding process for the father. The father's view of ultrasound as a reliable source of information was also investigated. A cross-sectional study of 25 men who were unaware of the fetal gender prior to sonography was performed. Nine boy (36%), four girl (16%), and twelve no preference (48%) were specified as the genders of choice. Nineteen of the participants (76%) stated that they had already formed a paternal bond with the fetus prior to ultrasound. Gender was not identified as the dependent factor for paternal bonding (92%). Most of the subject's reactions were positive regarding the results of gender identification (92%). All participants (100%) viewed the ultrasound examination as a reliable source of information and the sonographer as a skilled medical professional.
Improving Standards
Authors: Lea Jean H.
Published: March 2006

The primary goal for this column is to provide a communication link between sonographers, student sonographers, physicians, and educators concerning the various aspects of sonographer education. A few examples of these areas include curriculum design, innovative teaching methods, implementing an AMA-approved program, and questions regarding the ARDMS examinations. I will also be conducting a survey to try to identify the needs and concerns of sonographer educators.

Any sonographer, physician, or student who would like to submit an article for this column or has suggestions for topics of discussion in future columns may contact me at the following address:

Beth Anderhub, BSRT, CNMT, RDMS

Ultrasound Technology Program

St. Louis Community College

560 Oakland Avenue

St. Louis, MO 63110
Normal Sonographic Variants of the Neonatal Head
Authors: Hicks S. Elizabeth
Published: March 2006

Normal sonograms on 50 infants admitted to the Johns Hopkins Hospital Neonatal Intensive Care Unit were reviewed as to the echogenicity of the caudate nucleus relative to the thalamus. The infants were divided into two populations according to gestational age and birth weight. A review of sequential follow-up examinations showed that the caudate nucleus of those infants whose gestational ages were less than 32 weeks or who weighed less than 1,500 g increased in echogenicity as the infants matured. The caudate nucleus of those infants whose gestational ages were greater than 32 weeks or who weighed more than 1,500 g decreased in echogenicity as the infants matured. The author observed that the variation in caudate nucleus echogenicity was a normal finding, not pathologic, and was dependent on maturation and gestational age. Also noted was the incidence of a band of occipital echogenicity posterior to the occipital horns of the lateral ventricles. Its presentation in a large percentage of infants in both populations demonstrated it to be a normal variant.
Psychosocial Progression Through Normal Pregnancy
Authors: Lea Jean Hedrick
Published: March 2006

Social, cognitive, and psychologic aspects of normal pregnancy are discussed verbally and in a model format. The major anxieties arising from pregnancy, typical activities, and maternal-fetal attachment typical of each trimester are discussed. Ways in which sonographers can support pregnant patients during an ultrasound examination and further questions related to the development of optimum interaction strategies are explored.
Noninvasive Assessment of Lef Ventricular Size and Function in Infants and Young Children with Sickle Cell Anemia
Authors: Reyes Lynn K. , Curry Reva A. , Covitz Wesley , Arensman Frederick W. , Mckie Virgil , McKie Kathleen M. , Davis Harry
Published: March 2006

The authors evaluate the effects of sickle cell anemia in infancy, including increased heart rate and left ventricular diameter. Thirty-three asymptomatic infants and young children were studied using M-mode echocardiography to determine left ventricular size and function. The data indicate that left ventricular diameter is larger than normal and that cardiac function (VCF) may be below normal.
Ethical Issues in Ultrasound
Authors: Orange Theresa A.
Published: March 2006

Ultrasound has been, and still is, a medical field involved in rapid technological changes. These changes have introduced some new ethical issues to be considered by the ultrasound professional. This paper examines the reasons for sonographers to consider ethical issues in ultrasound as well as two categories into which these issues fall. The first category includes those ethical issues with which our patients and society must grapple. These are issues with which we are peripherally involved as technical participants but not as decision-makers. The second category includes ethical issues with which we, as health professionals, are intimately involved due to the nature of our profession. Some fundamental ethical problems involving the issues in each category are explored, and some individual issues are discussed.
Beyond 100 mW/cm2
Authors: Skelly Andrea C.
Published: March 2006

Given the publicity that sonographically induced biologic effects have received and the subsequent patient concern about potential hazards related to the use of diagnostic ultrasound, users of this modality must have a basic understanding of the physical principles, phenomena, and parameters associated with the production of biologic effects. An understanding of these concepts aids the user in putting reports of biologic effects into perspective, thereby enabling him/her to more effectively respond to patient inquiry and concern. This is the first of a series whose purpose is to introduce the user to the fundamental concepts and terminology associated with bioeffect production and reporting. This will provide a basis for discussing pertinent bioeffects literature and developing a scheme for putting reports of biologic effects into perspective.
Carotid Duplex Sonography in Patients Undergoing Abdominal or Peripheral Vascular Surgery
Authors: Walker Debbie
Published: March 2006

Duplex carotid sonography was performed on 80 patients undergoing abdominal or peripheral vascular surgery for atherosclerotic disease. High-grade stenosis (over 50%) of one or both common or internal carotid arteries was present in 17 patients. In three of these patients ischemic cerebral infarcts developed in the territory of the most severely stenosed artery within 1 to 40 days after surgery. The other patients had no postoperative central nervous system complications. Duplex carotid sonography is indicated in patients prior to vascular surgery in order to identify the group at risk for the development of cerebrovascular accidents. Carotid endarterectomy prior to or at the time of surgery may prevent this complication.