Which caval diameter? Clarification manufacturer's instructions for inferior vena cava filter use and implications for practice

AIM

To clarify manufacturer's instructions for inferior vena cava (IVC) filter use and implications for practice.

MATERIALS AND METHODS

Three vendors of IVC filters were contacted for clarification, with all stating that caval diameter limits are to be true maximum and true minimum cross-sectional diameters. To determine the implications of this, measurements were performed on 302 abdominal computed tomography studies in four transaxial dimensions perpendicular to the long axis including true maximum and minimum diameters, and measurements reflecting those typically taken on fluoroscopic cavography.

RESULTS

Based on the true maximum and true minimum caval diameter limits as clarified by vendors, 22% of patients who would typically be considered suitable for IVC filter insertion based on frontal and lateral fluoroscopic cavography would be contraindicated, and 40% of patients who would typically be considered suitable for IVC filter insertion based on only frontal fluoroscopic cavography (as lateral projection is often not performed) would be contraindicated.

CONCLUSION

There is a marked discordance between the vendor-clarified caval diameter limits of three common IVC filter devices and real-world caval geometry. Given the rarity of complications, this suggests a pressing need for revision of manufacturers' instructions for use statements to better reflect current safe routine clinical use, particularly from a medicolegal perspective.

Hepatitis services at an injecting drug user outreach clinic

AIMS

To provide a culturally appropriate, accessible and affordable hepatitis outreach clinic for injecting drug users, a traditionally hard-to-reach population.

METHODS

The community-based clinic, a collaborative project between the Wellington Drugs and Health Development Project and Capital Coast Health, was established in Wellington in 1997. Characteristics of the first 100 injecting drug users with hepatitis C assessed through the clinic are presented.

RESULTS

Of 51 patients found to be hepatitis C positive, five have received hepatitis C treatment, four at the outreach and one at a base hospital. 25 have been vaccinated for hepatitis B. The clinic has established trust and rapport with the injecting-drug-user community.

CONCLUSIONS

The hepatitis outreach clinic is an innovative project, crossing the primary/secondary interface of health services provision and providing personal health services within a public health initiative. The success of this model indicates potential value in offering outreach hepatitis clinics for injecting drug users in the major cities to close a gap in health service provision.

Patient literacy and the readability of written cancer educational materials

PURPOSE/OBJECTIVES

The purpose of this study was to determine whether the reading level of educational materials for patients with cancer corresponds to the reading abilities of a sample of patients. A secondary aim was to describe what type of educational materials patients with cancer report as most helpful.

DESIGN

Descriptive, cross-sectional.

SETTING

Outpatient oncology clinics at an urban Veterans Affairs Medical Center.

SAMPLE

A convenience sample of 63 outpatients with cancer.

METHODS

Investigators used the Word Recognition Achievement Test-Revised Level (WRAT-R2) to measure patients' reading levels. They used the Flesch Index to analyze the reading levels of the booklets that the patients used (14 booklets developed by the American Cancer Society and 16 developed by the National Cancer Institute). Data were analyzed through descriptive statistics and a Wilcoxon signed rank test.

MAIN RESEARCH VARIABLES

Patient and booklet reading levels.

FINDINGS

The reading level of 27% of the sample was less than that of all 30 pamphlets (less than a sixth-grade reading level). Seventeen percent of the patients had a reading level between sixth and eighth grades (representing 47% of the pamphlets). Twenty-nine percent of the sample had WRAT scores between 9th and 12th grades (representing 80% of the pamphlets). Only 27% had WRAT scores of the 13th grade and above. Twenty-six percent of the patients preferred written educational materials alone, while 57% of patients desired more than one method of instruction.

CONCLUSION

Written materials for the education of patients with cancer must be carefully matched to patient reading levels. Written materials may not be the only desirable mode of instruction.

IMPLICATIONS FOR NURSING PRACTICE

Given the increasing complexity of cancer care, shorter hospital stays, and a shift toward busy ambulatory care centers, nurses need to develop creative, innovative, and comprehensive patient education programs that are understandable to patients and that use multiple types of instruction.

Uses and implications of the contextual approach to child custody decisions

Child custody litigation signals parental conflicts that have serious implications for a child's long-term development. The authors describe a family systems approach to child custody decision making--the contextual approach, derived from contextual family theory. A case study analysis and pilot study illustrate the use of the approach with a small group of families who turn to the legal system to resolve custody or visitation disputes. The findings suggest the approach's usefulness in helping families create alternatives to continued disputation. The findings also reinforce the need for further research to test the preventive potential of the approach in reducing returns to court.