bluuebunny/crossref_metadata_2025 huggingface dataset:
A pilot study to assess the case for e-learning in the NHS
Authors: Dames David , Handscomb Ali
Published: March 2006

This paper considers the case for e-learning in the NHS. It highlights the findings of a three-month research project into the requirements for e-learners within clinical teams and the access to technology needed to support e-learners. The research was based on a three-month e-learning pilot using e-learning materials from three providers. Learners were recruited for the study by electronic means and by word of mouth. A questionnaire was administered before they began any learning, at eight weeks and then again at three months. The questionnaires were administered electronically, with a response rate of over 78%. Qualitative data were gathered from a discussion group and via e-mail responses to follow-ups from the questionnaire.
User involvement in research: Exploring the challenges
Authors: Beresford Peter
Published: March 2006

This paper looks at the issue of user involvement in research and evaluation. It is related to current discussions about research governance and research ethics. The regressive and liberatory potential of user involvement in research is explored, together with the ideological relations of such research. Competing strands in its development and approach are identified. The assumption is challenged that user involvement in research is a monolithic idea. User-controlled research as well as user involvement in research is examined and a case is made for more equal access to funding for it. The paper calls for systematic development and evaluation of user involvement in research, both to identify its strengths and weaknesses and to support its most effective development.
Research fraud: Why nurses should become aware
Authors: Kenkre Joyce E. , Semple Martin
Published: March 2006

As treatment and care given to patients should be evidence-based, nurses are becoming more involved in the conduct of research. However, research results based on fraudulent findings can have a serious impact on patient care. It is important, therefore, that nurses know how fraud may be perpetuated so that they do not risk unknowingly abetting or committing fraud themselves. Those who commit such acts stand to lose their academic credibility, the respect of their colleagues, and their livelihood. Mechanisms need to be developed within each institution to facilitate the conduct of quality research that can be audited. Nurses need to be advocates for quality research in the realisation that respect for the research findings will be achieved by respect for the maintenance of standards.
Facilitating practitioner research through critical companionship
Authors: Titchen Angie , McGinley Maeve
Published: March 2006

The investigation of practice by practitioners themselves is growing in nursing. It is now expected of many nurses that they will carry out research as part of their everyday practice, for example, in the case of consultant nurses. Nurses are also expected today to provide evidence-based care for their patients and their carers. Researching one's own practice, providing care based on rigorously gained knowledge of many types and giving a professional account of that practice are challenging activities for which many nurses need support. Based on that premise, this paper explores 'critical companionship' (Titchen, 2000; RCN, 2003), which can be described as a helping relationship based on trust, high challenge and high support, in which an experienced practitioner accompanies a less experienced practitioner on a learning journey. It is a means of enabling nurses to acquire, experientially, the knowledge and skills required for patient care and its development.

The concept of critical companionship is described within the context of a practitioner learning to investigate the nature and development of her own professional knowledge base and to transform her findings into potentially transferable ones. Findings relating to therapeutic use of self and its impact on patients are offered as an exemplar of this transformation process. In addition, a new conceptual framework for blending all types of knowledge through professional artistry is described. Collaborative testing of this framework within a critical companionship relationship is shown.

It is concluded from this piece of practitioner research that professional artistry is essential for genuinely evidence-based, person-centred care, and that it can be facilitated through critical companionship. The conclusion is also made, based on our own and others' work, that critical companionship is effective in enabling practitioners to gather, analyse and critique evidence from their own practice and to articulate this evidence to peers for critical scrutiny, public review and knowledge creation. The benefits of critical companionship for patients and carers are described.
A South West regional survey of factors affecting the future development and education of nursing and midwifery educators
Authors: Girot Elizabeth A. , Watkins Mary , Latter Susan , Goodman Benny , Jackson Dawn
Published: March 2006

To ensure that higher education institutions (HEIs) keep abreast of the changes advocated by the NHS modernisation agenda, a regional survey was undertaken to identify and analyse the development needs of individuals involved in the education of nurses and midwives in the South West of England. A total of 760 self-administered postal questionnaires were distributed with 426 returns, giving a response rate of 56%. This paper discusses the qualitative responses from the 57-item questionnaire that reported the factors facilitating (n=79) and inhibiting (n=140) the educators' personal development, and additional responses from those wishing to make further comment (n=125). From a content analysis it was noted that the themes identified as both facilitating and inhibiting development were inter-linked. The data from the additional responses served to reinforce the issues that had already emerged. Discussion revolves around the four refined themes of the need for greater resources, for a supportive organisation, for role organisation and development and for collaborative practice. Recommendations suggest greater clarification is needed of the roles of academics in practice and that they need more resources to support them in their achievement. Finally, the study reinforces the need for collaborative working across HEIs and the NHS if the modernization agenda is to be met.
Nursing management of children's pain: Current evidence and future directions for research
Authors: Franck Linda S.
Published: March 2006

This critical literature review discusses the research evidence underpinning each of the pain standards in the National Service Framework for Children: Standard for hospital services. Relevant evidence-based reviews and clinical practice guidelines are highlighted, and aspects of children's pain management where the research evidence is particularly strong or weak are identified. Priorities are suggested for nurse-led research aimed at generating new knowledge to improve pain management for children.
An exploration of the possible causes of occlusion problems in skin-tunnelled catheters used in paediatric oncology
Authors: Gordon Kim , Lloyd Andrew
Published: March 2006

Occlusion in children's skin-tunnelled catheters throughout the course of treatment for malignant disease can lead to increased physical and psychological stress. A two-phase study at a paediatric oncology centre aimed to identify the factors associated with occlusion in children's skin-tunnelled catheters.

The statistical findings show that occlusion problems were significantly more likely to occur in two groups of patients: those receiving dexamethasone as part of their treatment protocol, and children whose parents did not flush the line at home. In addition, the survey indicated that occlusion in skin-tunnelled catheters is a far more frequent problem than had been previously recognised. Further work is needed both to verify which factors are important and to guide future care of children with these catheters.
An evaluation of nurses' record-keeping skills and knowledge of using patient group directions for antibiotics at a walk-in centre
Authors: Brooks Nicky , Darmnng Frank , Bell Ian , Charles Joanne
Published: March 2006

Patient group directions (PGDs) are now an integral feature of walk-in centres (WiCs), enabling nurses to supply and administer drugs to the generalised direction of a doctor rather than by means of a patient-specific prescription. The aims of the study described here were to assess nurses' record-keeping and knowledge with regard to PGDs for antibiotics implemented at a local WiC.

The study methods included undertaking a clinical audit of patient records between October 2000 and March 2001 and an assessment of nurses' knowledge using multiple-choice questionnaires, vignettes and shadowing consultations. A total of 1,169 patients was supplied antibiotics, 72% of which were provided by nurses using a PGD. Nearly 100% of patients were supplied antibiotics correctly according to drug and dose; however, in only 63% of cases was there recorded evidence that allergy or contraindications were checked before the antibiotic was supplied. The study found that 51% of the required assessment criteria were recorded on the computer records. Nurses' knowledge at baseline resulted in a median score of 70%, which rose to 79% following educational interventions.

The study suggests that nurses are knowledgeable and supply antibiotics judiciously in terms of drug and dose, but that in terms of clinical governance there is room for improvement in record-keeping.
Profiling Black South African nurse pioneers: Promoting the Black biography
Authors: Mhlongo Thokozani
Published: March 2006

South Africa has produced some remarkable African nurses who have worked in a range of posts, and it is important that their contribution to the nursing profession is acknowledged. The value of a biographic approach to research as a means of understanding the profession's past, and the beliefs of the time of its leaders and institutions is discussed. A profile of one black South African nurse, Professor Thembani Grace Mashaba, is offered as an example of somebody who achieved high academic status despite humble beginnings and, moreover, during the years of apartheid in South Africa. It is contended that biographic research of high profile nurses and, in this case of a black female nurse, is a way of inspiring others and of increasing understanding of the nursing profession itself.
High, medium, and low security care: Does the type of care make any difference to the role of the forensic mental health nurse?
Authors: Dale Colin , Storey Les
Published: March 2006

This paper describes a survey of the educational preparation of nurses working in high, medium and low security mental health settings. Data from focus groups and interviews were also content-analysed to yield a theory of nursing in secure environments comprising of statements of competency.

The competences were translated into a questionnaire and distributed to nurses working in high, medium and low security mental health settings. Respondents stated whether individual competences were part of their current practice or supervisory involvement, and the degree of importance they accorded to each competency.

The competence framework received widespread support from nurses at all levels of security in relation to their role description and level of importance. Results identified issues in relation to security and how procedures in parts of the system (notably in high security) militate against therapeutic care. Noticeable differences emerged between respondents working in high and medium secure environments in relation to involvement of the patient's family and preparation for discharge. Issues of concern common to all levels of security included teamwork, balancing security and therapy, boundaries of professional practice, and clinical supervision.
Safety and security procedures in psychiatric acute admission wards
Authors: Cowman Seamus , Walsh Jim
Published: March 2006

Violence and assaultive behaviour is a serious and growing problem in psychiatric services across the world. Despite many concerns about violence and assault in healthcare, there is an alarming lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals.

This paper describes the safety and security measures in psychiatric acute admission wards in the Republic of Ireland and may be considered to be representative of acute psychiatric settings in other jurisdictions. A population study was undertaken, which included all psychiatric acute admission wards in the Republic. A descriptive survey research design was adopted, with the use of a questionnaire for data collection. The questionnaire was analysed using SPSS (version 11) and descriptive statistics were used to present the results.

There was wide variation in safety and security practices across the wards. Measures aimed at ensuring staff security were also lacking, with no overall acceptable minimal standards discernible. It may be concluded that there is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards. One has to ask to what extent the disparate practices in safety and security revealed in the results of the study account for the escalation in violent episodes and assaultive behaviour in psychiatric services in recent years.
Estimation of Fetal Weight by Ultrasound in Term Pregnancy
Authors: Fleming Alfred , Riva James Dalla , McAdoo Gregg
Published: March 2006

The objective of the present study was to determine which of the established methods of estimating fetal weight in term and large fetuses is the most accurate. In a study population of 116 term gestations, an ultrasound examination was performed within 7 days of delivery. Each ultrasound measured abdominal and head circumference, biparietal diameter, and femur length using uniform measurement and scanning method criteria. Five different methods were used to calculate estimated fetal weights. Of the five current formulas used to estimate fetal weight in term and large fetuses, the four-parameter method of Hadlock provided the best estimate. The accuracy of estimating fetal weight by ultrasound in term and large fetuses can be improved by using multiple parameters, which in turn may influence clinical judgment in the timing and management of delivery.
Transvagina1 Hysterosonogram
Authors: Kennedy Gale
Published: March 2006

Transvaginal hysterosonography is used to evaluate the endometrial lining in postmenopausal women by outlining the endometrium with fluid. Indicators for this examination include: enlarged uterus on physical examination, hypermenorrhea, dysmenorrhea, amenorrhea, postmenopausal bleeding, a thickened or irregular endometrial lining seen with ultrasound, and endometrial fluid. Sonographic finding include endometrial polyps, myomata, intrauterine synechiae, hyperplasia, and endometrial cancer.
Mirror Image Artifact Produced by Cardiac Pacemaker
Authors: Hedrick W. R. , Milligan Carol L.
Published: March 2006

A clinical example of a mirror image artifact produced by a cardiac pacemaker is presented. The formation of this mirror image artifact is discussed with illustrative figures.
A Comparison of Ultrasound and Surgical Findings in Suspected Ectopic Pregnancy
Authors: Rogers Rebecca G. , Kammerer-Doak Dorothy , Miller Michelle , Byrn Francis , Conway Susan , Hall Rebecca
Published: March 2006

A retrospective review was conducted of patients assigned ICD-9 codes for ectopic pregnancy between 1993 and 1996, to compare ultrasonographic assessment with surgically confirmed anatomic pathologic conditions. Demographic information, ultrasound findings, operative reports, and pathology reports were assessed. One hundred thirty of 154 patients (84%) who underwent surgery for treatment of ectopic pregnancy had preoperative ultrasound examinations. Ultrasound findings of an adnexal mass correctly predicted the presence of an ectopic pregnancy subsequently confirmed at surgery in 91 of 130 women, yielding a sensitivity of 70%. The sensitivity of sonographically predicting the location of an ectopic was 60%, and the presence of hemoperitoneum was 78%. Despite advances in technology, sonography should be used in an ancillary role to clinical judgment in the assessment algorithm of this common clinical condition.
Extended Field of View Real-Time Ultrasound
Authors: Hedrick W. R.
Published: March 2006

The technique of extended field-of-view real-time imaging is discussed with illustrative examples. Advances in computer technology enable a panoramic image to be formed as a real-time transducer is moved across the patient. Registration of multiple-image frames is accomplished without position sensors using image feature matching. Advantages and limitations of extended field-of-view imaging are presented.
Dissection of the Common Carotid Artery
Authors: Best Graciela A.
Published: March 2006

Dissection of the aorta is a common catastrophic event affecting the aorta. However, aortic dissections do not normally extend into the common carotid arteries. This case study discusses such an occurrence and the role of sonography in its detection and diagnosis.
Sonographic Appearance of Primary Fallopian Adenocarcinoma
Authors: Stephenson Susan Raaiz , Layton Gertrude A. , Little Kenneth
Published: March 2006

Fall1opian tube adenocarcinoma is a very rare reproductive neoplasm. Endovaginli sonography is an excellent modality with which to visualize female reproductive cancers; however, misdiagnosis is common due to sonographic similarities with other pelvic pathology. Fallopian tube and ovarian cancers are histologically similar and may also appear similar by sonography. We present a case of fllopian tube adencarcinoma.
A Follow-Up Study of Diagnostic Medical Sonography Graduates
Authors: Adebayo Bob
Published: March 2006

This study was undertaken to provide baseline data on the ptacties and activities of graduates of the Diagnostic Medical Sonograpphy (DMS) program at Central Ohio Technical College. The results show that'graduates were upwardly mobile in their careers and believed that their training prepared them well for their job.
Pelvic Varices Mimnicking Placenta Percreta at Sonography
Authors: Russ Paul D. , Tomaszewski Garin , Coffin Carolyn
Published: March 2006

Abnormal placentation refers to pathologic adherence of the placenta to the uterus.1-3 Three subtypes are defined based on depth of myometrial invasion by nonneoplastic chorionic villi. Superficial, deep, and transmural involvement are termed placenta accreta, increta, and percreta, respectively. Of the three, placenta percreta is the rarest type, occurring with a frequency of only 1:33,000-90,000 deliveries.3 The antepartum diagnosis of placenta percreta is crucial because the associated vascular involvement of the myometrium and surrounding pelvic structures can result in massive blood loss, fetal demise, and maternal death at delivery. An imaging feature of placenta percreta is the sonographic demonstration of abnormal vascularity within the placenta, subplacental complex, and adjacent organs such as the bladder.1,2,4-8

Pelvic varices are dilated veins (T 5 mm) that can occur during pregnancy or in non pregnant women.9'-5 These enlarged veins commonly involve the broad ligaments and parametrium, and, as a result, they often abut or surround the uterus, lower uterine segment, and cervix. Although pelvic varices can be prominent, they rarely cause obstetrical complications (Gibbs R, personal communication).

We report a case of pelvic varices mimicking placenta percreta with bladder invasion. The antenatal diagnosis of placenta percreta radically altered the patient's management. Although only unusual pelvic varices were subsequently documented at cesarean hysterectomy, the extremely cautious care necessitated by the presumptive sonographic diagnosis of placenta percreta was warranted to avoid a potential obstetrical catastrophe.
Hepatic Candidasis Complicating Acute Myelogenous Leukemia: Sonographic, CT, and MRI Findings
Authors: Moffatt Michael D. , Pantelic Milan V. , Zylak Carl
Published: March 2006

A case of disseminated candidiasis complicating leukemia is presented. The complementary roles of sonography, computed tomography, and magnetic resonance imaging are compared.
A Sonographer's View of Agenesis of the Corpus Callosum
Authors: Schnetzer Joseph
Published: March 2006

This comprehensive overview of agenesis of the corpus callosum, including two case presentations, discusses not only the ultrasonic appearance and diagnosis of this congenital malformation, but the function, location, pathogenesis, etiology, clinical picture, and other modes of diagnosis. This is especially important for the ultrasonographer who is responsible for recognizing the sonographic manifestations of the various neurologic anomalies that can be demonstrated.
Report on the American Registry of Diagnostic Medical Sonographers Examinations, October 27-28, 1984
Authors: Early Larry Allan
Published: March 2006

The American Registry of Diagnostic Medical Sonographers (ARDMS) administered more than 5,400 examinations to more than 2,600 candidates on October 27-28, 1984, at 23 test centers across the United States and Canada. Of these, 1,441 candidates became Registered Diagnostic Medical Sonographers (RDMS) andlor Registered Vascular Technologists (RVT) and 404 RDMS/RVTs became registered in an additional specialty. Since 1975, when the Registry by examination procedure began for diagnostic medical sonography, more than 8,200 professionals have earned certificates. A discussion of the examination administration of 1984 as well as statistical results are included in the following report.
Hydronephrosis in Pregnancy
Authors: Garten Katrina J. , Pulliam Robert P.
Published: March 2006

Two cases of significant hydronephrosis of pregnancy and their management are detailed. Measurements of calyceal diameters in control and pregnant patients of varying gestational ages are presented. Calyceal dilatation in pre-and postvoid states for all patients examined is compared, with no differences noted. Although there was a general trend toward increasing calyceal diameters throughout pregnancy, high intragroup variation was present in each group. There were no significant differences detected between gestational age groups and between right and left kidneys. Ultrasonography can be used as the initial method of evaluation in symptomatic pregnant patients. The absence of hydronephrosis virtually eliminates obstructive disease, while significant hydronephrosis may be present without disease. The hydronephrosis of pregnancy is highly variable and exhibits wide ranges of physiologic change. Medical management should be based on symptomatology rather than "hydronephrosis" as a pathologic diagnosis.
Emphysematous Pyonephrosis
Authors: Dierks Paul R. , Clark Robert A. , Spitz Harold B.
Published: March 2006

Two cases of emphysematous pyonephrosis are presented and discussed. Resulting from the extension of a renal infection into an obstructed collecting system, emphysematous pyonephrosis usually occurs in patients with diabetes mellitus, is usually unilateral, and generally has a poor clinical prognosis. Sonographically, emphysematous pyonephrosis presents as strong echoes near the renal sinus with acoustic shadowing and/or reverberation artifacts.
Dealing with Feelings
Authors: Craig Marveen
Published: March 2006

Stress and burnout are significant problems for the sonographer as well as for other hospital workers. It is therefore essential that the ultrasound community realize that these problems exist. These growing conditions, their consequences, and possible solutions are presented here; and the author suggests methods for coping with stress and heavy workloads.
Ultrasonic Guidance of Prosthetic Hip Joint Effusion Aspiration
Authors: Paul Dennis E.
Published: March 2006

Until recently ultrasound imaging of the orthopedic patient has been limited. A new technique is presented here for the use of ultrasound imaging in guiding prosthetic hip joint effusion aspirations. Previously, x-ray fluoroscopy was used for these procedures. The use of ultrasound allows the examiner to directly visualize the abnormal fluid collection without using contrast injections, provides a three-dimensional orientation of the anatomy, and eliminates the x-ray exposure to the patient and the staff.
An Introduction to Carotid Duplex Sonography
Authors: Poehlmann H. W. , Bigongiari L. R.
Published: March 2006

During the last 5 years there has been a great increase in the use of carotid duplex sonography (CDS) for the evaluation of carotid disease. CDS is complementary to the other noninvasive tests. CDS is useful for following post endarterectomy patients and those with nonspecific symptoms. It is also useful in identifying minor as well as significant carotid artery disease. With rapid proliferation of the modality, caution must be exercised so that high standards of performance are maintained. A systematic approach to the examination must be taken for the best results.
False-Positive Sonography of Solid Testicular Lesions
Authors: DiGiacinto Thomas M. , Clark Heidi , Willscher Max , Conway James
Published: March 2006

The authors have retrospectively analyzed and correlated with surgery the solid testicular ultrasound findings of 43 patients and review five false-positive cases.
Ultrasound and CT-Guided Percutaneous Interventiona Procedures of the Abdomen
Authors: Nash Wendy , Fabian Thomas , De Lange Marie
Published: March 2006

Percutaneous interventional procedures have played an increasingly important role in patient management. This is primarily due to the application of diagnostic ultrasound and computerized tomography as imaging modalities to provide accurate guidance for these procedures. The purpose of this article is to review the use of ultrasound and computerized tomography in biopsies and in drainage procedures of the abdomen.
The Role of Sonography and CT in Urosepsis
Authors: Jeffrey R. Brooke , Vernacchia Fred S.
Published: March 2006

Both computerized tomography (CT) and sonography are important imaging techniques in patients with major renal infections. Sonography should be performed as the initial screening examination to exclude pyonephrosis or a large renal or perirenal abscess. In patients who continue to have persistent sepsis without adequate explanation by sonography, CT should be performed to characterize the nature of the renal inflammatory process.
The Role of Ultrasound in Orbital Evaluation
Authors: Haik Barrett G. , Smith Mary E.
Published: March 2006

Ultrasound is a valuable and practical extension of a clinical ophthalmic examination. It is noninvasive, does not use ionizing radiation, is portable, and allows for rapid acquisition and assessment of images. Acoustic characterization of orbital lesions often permits a secure clinical diagnosis to be established. Orbital ultrasound is thus a highly reliable, easily performed examination technique which can guide further diagnostic testing and monitor the patient's response to clinical therapy.
Sonography of the Spleen
Authors: Sieler Lynn A.
Published: March 2006

With the advent of real-time sonography of the upper abdomen, the spleen is no longer an inaccessible organ. Real-time imaging is preferable to other conventional diagnostic methods because of its simplicity and accuracy in evaluation of the spleen and the determination of its relationship to other organs. This review of the literature details the diagnosis of splenic pathology by sonography and includes a discussion of the significance of these findings.
A Statistics Refresher
Authors: Khamis H. J.
Published: March 2006

Two key concepts that are used frequently in statistical applications are tests of hypothesis and diagnostic test evaluation. In this article, the rationale behind the testing of statistical hypotheses and the description of the "rare event approach" to statistical inference are discussed. Also, the development of diagnostic test evaluation, a technique that is particularly important in statistical applications of a biomedical nature, is presented. In the development of these techniques, the mathematics are minimized and the conceptual framework and logic are emphasized.
Transrectal Ultrasound in the Follow-up of Patients with Prostatic Cancer
Authors: Hofmann R. , Braun J.
Published: March 2006

Prostatic volume and echo pattern of the prostate were evaluated in 30 patients with prostatic cancer stage A-C prior to radiotherapy and up to 12 months following treatment. When compared with patients who underwent castration because of metastatic prostatic carcinoma, the volume reduction of the prostate was less pronounced. After only 1 month, a significant volume decrease was measured in both groups. After radiotherapy, a continuous concentration of echogenity resulted, whereas after orchiectomy, a discrete disintegration of the echoes was noted followed by increased echogenity.
Methyl Methacrylate as a Moldable, Implantable Biomaterial for Use with Ultrasound Transducers
Authors: Sites Jeffrey P. , Favino James , Bowes Donald E.
Published: March 2006

Polymethyl methacrylate (PMMA), an arthroplastic implant material, has been explored as an implant medium for Doppler transducers for blood flow detection in the deep and peripheral vascular bed. A mixture ratio of 0.5 parts polymerized PMMA to 1.0 part monomeric methyl methacrylate (MMA) was found to yield satisfactory characteristics. A significant lack of tissue reaction was noted; at worst, a generalized mild inflammation attributable to implantation surgery was found in both test subjects and controls. Signal transmission was found to be unaltered by comparison of signal characteristics with the prepared implant probe and an uncoated transducer in the surgical site. Examination of the probes, after as long as 4 months, demonstrated no failure due to material characteristics. PMMA is an efficient bonding and moldable compound and is desirable because of its acoustic properties for implantable ultrasound applications.
Infantile Hypertrophic Pyloric Stenosis
Authors: Thai Shirley Q. C. , Rouse Glenn A. , DeLange Marie , Grube Gerald L.
Published: March 2006

Infantile hypertrophic pyloric stenosis is an important cause of vomiting in the first 6 weeks of life in a neonate. Because the vomiting can lead to dehydration and electrolyte imbalance, the condition is life-threatening if left untreated. Clinically, the diagnosis of pyloric stenosis is made by palpation of a hard muscular mass about the size of an olive in the upper abdomen. Sonographic diagnosis is based on a pyloric muscle thickness of 0.4 mm or greater and pyloric canal elongation equal to or greater than 1.8 cm. Because sonography offers a direct evaluation of the pylorus and it is noninvasive, it should be recognized as a primary modality in diagnosing infantile hypertrophic pyloric stenosis.
Diminishing Exposure to Doppler Ultrasound
Authors: Taylor Kenneth J. W. , Kremkau Frederick W.
Published: March 2006

Diagnostic ultrasound has an unblemished record for safety. The introduction of pulsed Doppler may involve higher intensities exceeding 1 W/cm2 (SPTA). These intensities must cause concern for fetal exposure, and the FDA has introduced strict guidelines to limit such exposure. Presented here are practical ways in which sonography can minimize exposure. These include the use of Doppler only when clinically indicated or part of an approved research protocol, knowledge of the emitted intensity, and how to attenuate this to prudent levels. It is desirable to use sensitive equipment and increase the TGC before increasing power. Such prudent use will allow ultrasound to be used in these new applications without hazard.
Statistics Refresher II
Authors: Khamis H. J.
Published: March 2006

One of the important considerations in the planning of any experiment involving statistical analysis of data is the sample size to be used. The appropriate sample size for a given experiment depends upon the hypotheses being tested, the kind of statistical test being applied, the degree of accuracy required by the researcher, and other factors. Generally, it is not appropriate to make an intuitive guess at what the appropriate sample size should be; nor is it always true that "the larger the sample size, the better."
Intrauterine Diagnosis of Abdominal Wall Defects
Authors: Beckley Beverly , De Lange Marie , Rouse Glenn , Grube Gerald
Published: March 2006

Ultrasound is an important tool in the evaluation of fetal development and detection of fetal abnormalities. The ability to detect abnormalities in utero can help improve perinatal care; therefore, a detailed sonographic examination of the fetus should always be obtained. Abdominal wall defects that can be recognized by sonography include omphalocele, gastroschisis, umbilical cord hernia, and limb/body wall complex. The sonographer should attempt to give a detailed description of the defect including the organs involved, the presence of a sac, the site of cord insertion, and the presence of any associated anomalies. This information can aid the physician and parents in determining the course of management of the pregnancy.
Sonography of Appendicitis: A Review
Authors: Gisler Melanie , Rouse Glenn , DeLange Marie
Published: March 2006

Acute appendicitis is the most common cause of emergency abdominal surgery. A review of recent literature utilizing sonography for evaluation of appendicitis demonstrates a range of specificity from 95% to 100% and sensitivity of 80% to 89%. Using sonography to assess a patient for appendicitis may assist in differentiating this entity from an ovulating patient thus reducing false-positive surgeries.
Predictive Value of Technically Adequate and Normal Abdominal Sonography Prior to Retrograde Cholangiopancreatography
Authors: Cunningham Jerome J. , Bicani-Faulls Monica
Published: March 2006

A prospective study identified 85 patients who had endoscopic retrograde cholangiopancreatography (ERCP) within 60 days of a technically adequate sonogram of the biliary tree and pancreas which was normal using strict criteria. Eighty-two normal sonograms ultimately proved to be true-negatives and two were false-negatives. The correct diagnosis is uncertain in one patient. The three incorrect or potentially incorrect sonograms were performed in the first year of a 2-year study. Patients who have both a technically acceptable and completely normal sonogram of the biliary tree and pancreas are very unlikely to have an abnormal ERCP.
Image and Signal Processing in Diagnostic Ultrasound Imaging
Authors: Hedrick W. R. , Hykes D. L.
Published: March 2006

An overview of signal-processing techniques used in the acquisition, display, manipulation, and analysis of echo scan data is presented. The principles of time-gain compensation, selective enhancement, log compression, fill-in interpolation, edge enhancement, image updating, write zoom, gray scale mapping, black/white inversion, freeze frame, frame averaging, read zoom, thresholding, contrast enhancement, filtering, and region-of-interest definition are reviewed. The concept of gray scale mapping, which dictates how the stored scan data are displayed, is explained with many illustrative examples.
Tricuspid Regurgitation
Authors: Waggoner Alan D. , Perez Julio E. , Barzilai Benico , Cash Nancy
Published: March 2006

A complete noninvasive assessment of patients with suspected tricuspid regurgitation should include two-dimensional echocardiography, color flow imaging, and continuous wave Doppler. Two-dimensional echocardiography may be used to demonstrate abnormalities in tricuspid valve morphology as well as changes in right heart size and function due to tricuspid regurgitation. Color flow imaging provides a semiquantitative method for determining the presence and extent of tricuspid regurgitant jet area. When tricuspid regurgitation is present, continuous wave Doppler is used to measure right ventricular (or pulmonary artery) systolic pressure by means of the modified Bernoulli equation of 4 X regurgitant jet velocity2 plus an assumption of the value of right artrial pressure. Contrast-enhancement of tricuspid regurgitant jet signals may be necessary if continuous wave Doppler does not delineate the jet envelope.
Sonography of Thanatophoric Dwarfism: A Review
Authors: Brandon Paula S. , Rouse Glenn A. , Delange Marie
Published: March 2006

Thanatophoric dwarfism is the most common form of lethal skeletal dysplasia and accounts for one of 246 perinatal deaths. The obstetric ultrasound examination is a primary diagnostic tool in the antenatal detection of thanatophoric dwarfism. Characteristic findings include thickened, shortened, and bowed extremities, a small, narrow thorax, flattened vertebral bodies with wide intervertebral disk spaces, and enlarged calvarium which may include cloverleaf skull deformity, pronounced skin thickening, and characteristic facies. In addition, polyhydramnios and nonimmune hydrops are occasionally seen with this entity. Sonographic features of this disease may allow its identification at an early fetal age. The obstetric sonographic examination, when combined with radiography, is definitive for diagnosis of thanatophoric dwarfism and can have a major impact on clinical management.
Campomelic Skeleta-l Dysplasia with a Narrow Thorax
Authors: Carlan Stephen J. , Parsons M. T. , Flasher J.
Published: March 2006

This report describes the typical findings of campmelic skeletal dysplasia, a rare congenital disorder characterized by bent femurs, a narrow chest, and usually, a fatal outcome.
Embryonic Heart Rate and Age
Authors: DuBose Terry J. , Cunyus James A. , Johnson Laurence F.
Published: March 2006

This study used linear regression analysis to show that embryonic heart rate (EHR) can be used in the clinical setting to provide an estimate of embryonic age that correlates well with the fetal crown-rump length age (CRL; r = 0.856). A regression was performed on data from 275 examinations in which an embryonic heart rate was recorded before the ninth menstrual week from a cross-sectional population of 1,136 examinations throughout pregnancy. In this analysis, EHR was used as the independent variable and CRL as the dependent variable to yield the following formula for CRL age in menstrual days: CRL Age (menstrual days) = 8.18 + 0.285 EHR. Based on this result, a rounded version of the formula was sought that would provide essentially the same estimated fetal age as the regression formula for the range of EHR that occurred in the sample (84-193 beats/min) yet allow for a simpler computation. Within that range of EHR, the following clinical versions of the regression formula were found to produce results that did not differ significantly from the original formula: Days of Gestation = 0.3 EHR -8 and Menstrual Days Age = 0.3 EHR + 6. Both the original regression and the clinical versions yielded 95% prediction intervals of approximately ± 8 days across the range of EHR that occurred in the sample. While fetal age based on this method is only an approximation of the CRL age, the heart rate can be obtained using time/motion mode sonography when only the less accurate gestational sac diameters are available. The EHR is useful to corroborate early age estimates, especially when using transvaginal transducers and may provide useful information concerning cardiac development.
An Application of Bayes' Rule to Diagnostic Test Evaluation
Authors: Khamis H. J.
Published: March 2006

It is often the case that a clinician has diagnostic values such as sensitivity and specificity available for a certain diagnostic test but not the positive or negative predictive values. Because the clinician uses these predictive values to make decisions concerning the wellbeing of the patient, it is important to be able to compute them from the sensitivity and specificity. This article presents a well-established theorem called Bayes' rule for doing this. A brief, intuitive development of Bayes' rule and the framework for this application is given with a minimum of mathematics and without proofs. Several examples are provided.
Real-Ti me Ultrasound Instru mentation
Authors: Hykes David L. , Hedrick Wayne R.
Published: March 2006

Real-time ultrasound imaging techniques have almost totally replaced static B-mode gray scale imaging. The increased use of real-time imaging is the result of advances in transducer technology, the miniaturization of electronics through the development of digital circuitry, advances in computer software, and improved ultrasonic focusing. The final result has been an increase in image quality and information content for real-time ultrasound. A review of basic real-time ultrasound instrumentation is presented. Sector scanners, linear arrays, and phased arrays are discussed in detail. Electronic focusing methods (transmit and receive focusing) are explained with many illustrative examples. The new imaging technique of endosonography or transonography is introduced.
Sonographic Detection of Fetal and Neonatal Intrathoracic and Pulmonary Abnormalities
Authors: Green Ida L. , Grube Gerald L. , Rouse Glenn A. , Tan-Sinn Phil-Ann
Published: March 2006

High resolution ultrasound has allowed increased definition and detailed study of the fetal thorax. From the second trimester, congenital anomalies arising from or involving the fetal chest can be visualized. Early detection and diagnosis of fetal intrathoracic abnormalities are rapidly becoming an integral part of modern obstetrical care and neonatal management. The potential exists to diagnose most intrathoracic anomalies before the 20th week of pregnancy.
Sonographic Diagnosis of a Viable Ampullary Tubal Pregnancy at 14 Weeks Gestation
Authors: Sherer David M. , Smith Susan A. , Allen Tamara , Woods James R.
Published: March 2006

Tubal pregnancies rupture commonly between 6 and 10 weeks gestation. An unusual, sonographically diagnosed, viable 14-week ampullary tubal pregnancy is presented. The multiple sonographic growth parameters were appropriate for gestational age. Expedient surgery was performed.
Image Recording Devices
Authors: Hedrick W. R. , Hykes D. L.
Published: March 2006

An overview of image recording devices that include multiformat camera, laser camera, polaroid film, video printer, color video printer, and video cassette recorder is presented. The principles of operation for each device are discussed. Advantages and disadvantages of the various archiving techniques are compared.
Duplex Sonography in the Evaluation of Pancreas Transplants
Authors: Newberry Lisa B. , Nelson Rendon C.
Published: March 2006

Multiple allograft duplex sonographic examinations were performed on six patients who underwent pancreas transplantation to determine the role of this imaging modality. Poor correlation was found between gland size, parenchymal echogenicity or resistive index, and either rejection and/or cyclosporine toxicity. The pancreatic duct was not dilated on any of the examinations. Seven peripancreatic fluid collections were noted but were generally small. In one patient, no Doppler frequency shifts were found in spite of extensive interrogation of the parenchyma and subsequent biopsy confirmed allograft infarction. Duplex sonography appears most useful for excluding ductal dilatation, for detecting peripancreatic fluid collections, and for identifying infarction.
Congenital Diaphragmatic Hernia
Authors: Bennett Barbara Hutter
Published: March 2006

Ultrasound is most often prescribed in obstetrics for routine dating procedures. In routine exams fetal anomalies may be detected. Congenital diaphragmatic hernia (CDH) is a fairly rare anomaly that has been detected in utero with ultrasound. The sonographic features of CDH may be very subtle, and sonographers need to be knowledgeable and skilled to detect the abnormality.
Carcinoma of the Prostate
Authors: Kammermeier Michael J.
Published: March 2006

Carcinoma of the prostate is a disease that threatens most men of advanced age. Early diagnosis can greatly improve the prognosis. With the use of ultrasound, the prostate can be visualized and many subtle changes can be documented. This article reviews the anatomy and sonographic appearance of the normal prostate as well as that of prostatic carcinoma. A detailed description of the scanning techniques, including the transabdominal, transperineal, endourethral, and endorectal approaches, is provided. The advantages and disadvantages of each approach, the equipment that is necessary, and ultrasound-guided biopsies are also discussed.
The Quantification of Cardiac Performance
Authors: Reynolds Terry , Halfman-Franey Marsha
Published: March 2006

A debate has arisen as to whether cardiac performance should be quantitatively or qualitatively analyzed in the modern cardiac ultrasound laboratory. In order to actively participate in this debate, the cardiac sonographer should have a basic understanding of the terms that describe cardiac performance. The following paper presents a description of these key terms and links them directly to the everyday practices of the echocardiography laboratory.
Deciding on the Correct Statistical Technique
Authors: Khamis H. J.
Published: March 2006

Researchers are often faced with the need to choose the correct statistical technique for a given data analysis problem. There are a number of criteria that should be used to guide them in making the choice: their research questions, the nature of the variables involved, the sample size, and the distributional behavior of the data, among others. This article provides guidelines on the nature of the study variables, which will help researchers select the proper statistical technique. Of course, all statistical techniques have certain underlying assumptions, which must be checked before the technique is applied.
Preoperative Endovaginal Sonographic Diagnosis of an Unruptured Interstitial Pregnancy
Authors: Sherer David M. , Roberts David , Rideout Juliana , Scibetta Joseph J. , Dubeshter Brent , Kogut Peter L. , Abramowicz Jacques S.
Published: March 2006

Interstitial pregnancies carry a higher maternal morbidity and mortality rate, due to the abundant ovarian and uterine arterial supply of this region, than do other tubal pregnancies. Prerupture diagnosis is crucial, inasmuch as rupture (which usually occurs at a later stage than in tubal gestations) may be followed by rapid exsanguination. Precise early diagnosis may permit conservative nonsurgical treatment with methotrexate. A case is presented in which preoperative diagnosis of an unruptured interstitial pregnancy was aided by endovaginal sonographic examination. Considerations of subsequent management are discussed.
Transvaginal Sonographic Evaluation of Prostatitis in a Transsexual
Authors: Feldhamer Leon , Grimmond Arlene , Gerard Perry
Published: March 2006

A transsexual (male to female) patient reported a 1-month history of pelvic pain. After an unsuccessful transvesical pelvic ultrasound examination, a transvaginal ultrasound examination was attempted through the surgically formed vagina. The utility and indications of this route of examination in transsexuals, as well as the changes that develop in the prostate of patients who receive long-term estrogen therapy, are discussed.
Secondary Dysmenorrhea Associated with Residual Calcified Chorionic Villi
Authors: Foy Pamela M. , Blumenfeld Michael L. , Fleming Christopher M.
Published: March 2006

Transvaginal ultrasound has proven to be an excellent diagnostic tool for evaluation of the endometrial lining of the uterus. This case report describes a focal echogenic foci visualized within the endometrial lining that was shown by pathologic examination to be immature calcified chorionic villi.
The Value of Transvaginal Ultrasound and Doppler in the Evaluation of Ovarian Teratomas
Authors: Carlson Carol J. , Gwin-Stewart Juli
Published: March 2006

Detection of ovarian teratomas can be a challenge to the sonographer. This case report demonstrates the value of transvaginal scanning and Doppler methods to improve detection and evaluation of these pelvic masses.