Precision of Hyaline Cartilage Thickness Measurements

Measurement of cartilage thickness in vivo is an important indicator of the status of a joint as the various degenerative and inflammatory arthritides directly affect the condition of the cartilage. In order to assess the precision of thickness measurements of hyaline articular cartilage, we undertook a pilot study using MR imaging, plain radiography, and ultrasonography (US). We measured the cartilage of the hip and knee joints in 10 persons (4 healthy volunteers and 6 patients). The joints in each patient were examined on two separate occasions using each modality. In the hips as well as the knee joints, the most precise measuring method was plain film radiography. For radiographs of the knees obtained in the standing position, the coefficient of variation was 6.5%; in the hips this figure was 6.34%. US of the knees and MR imaging of the hips were the second best modalities in the measurement of cartilage thickness. In addition, MR imaging enabled the most complete visualization of the joint cartilage.

Histologic correlation with magnetic resonance imaging for benign and malignant lipomatous masses

Purpose/results. We evaluated the diagnostic accuracy of magnetic resonance imaging (MRI) for 46 consecutive patients with lipomatous soft tissue tumors prior to biopsy and resection. Twenty-eight patients had benign lipomas and 18 had liposarcomas. Clinical differences between thdse patients with benign disease and those with malignant lesions were average age at the time of presentation (49 years for benign vs 62 years for malignant, p < 0.001) and average length of symptoms prior to resection (64 months for benign versus 38 months for malignant, p = 0.01). MRI characteristics associated with benign disease included: smaller tumor size (9.4 cm average greatest dimension for benign lesions vs 13.4 cm for malignant masses, p = 0.022); a mass with a uniformly homogeneous signal (p = 0.0003); a mass with homogeneous high T1 and T2 signals and a low short-time-inversion-recovery (STIR) signal comparable to normal fat (p < 0.0001). This last signal pattern was not seen in malignant lesions (0/18) and was present in almost all benign lipomas (25/28). The usual MRI descriptions of soft tissue masses such as infiltrating vs encapsulating, deep vs subcutaneous and septated vs non-septated were not helpful predictors of malignancy in this series. Needle biopsies of lipomatous masses with heterogeneous signals on MRI resulted in inaccurate diagnoses due to sampling error in 5/9 patients.

Discussion. A carefully planned and performed MRI study of lipomatous masses can accurately predict a benign lipoma whenever a homogeneous high T1 and T2, as well as a low STIR, signal is present. However, a mass with any other signal characteristics must be biopsied carefully in order to make an accurate diagnosis.

Digital radiographic image archival, retrieval, and management

Data in the health care environment can encompass a wide range of contents, each representing one aspect of health care delivery. Examples of such a diverse and yet related content are diagnostic images, laboratory results, patient history, hospital administration, and insurance and payer coverage. The focus of this article is the handling of diagnostic imaging in general and radiographic imaging in particular, therefore fundamental concepts and issues are presented and discussed.

Invisible residents: the chronically mentally ill elderly in nursing homes

This article presents results from a retrospective study of psychological assessments of elderly persons with chronic mental illness residing in nursing homes. All residents (N = 570) received this assessment as part of federally mandated screening for mentally ill persons residing in long-term care. The process, the Preadmission Screening and Resident Review, was mandated by the Omnibus Budget Reconciliation Act (OBRA 87). These assessments were the first stage in a process to determine if the nursing home was the most appropriate placement for each resident. If nursing home care was deemed appropriate, then a psychological treatment program was to be established within the nursing home setting. The sample ranged in age from 50 to 104 (mean of 70). The majority had a diagnosis of schizophrenia and a history of psychiatric hospitalization occurring early in their life. The assessments did not include any quantifiable data on activities of daily living, cognitive functioning, or level of psychiatric impairment. Therefore, the researchers coded the narrative data so that it could be interpreted. The majority functioned within the none-to-mild range of cognitive impairment, and very few were completely dependent in the need for physical care. The most recorded symptom was social withdrawal. Neuroleptic medications were administered to 64% of elderly persons with chronic mental illness. Importantly, there was no relationship between demographic or clinical information and treatment recommendations. Implications of these findings for psychiatric nurses are discussed.

What interventions do nurses use in long-term care?

This study validated that the Nursing Interventions Classification is appropriate for use in long term care. It is comprehensive and supports the interventions nurses need and use in long term care practice. There is a need for additional research to determine its usefulness in other settings and with other patient populations, as well as studies based on practice versus respondent's opinion. For the elderly clients alone, there are many settings in which to verify use of NIC; including residential, assisted living, independent living, intermediate care units, skilled care units, low-stimulus units, hospice, adult day care and the emerging specialty units. An important next step will be to note the similarities and differences of interventions used across these settings to discern practice setting needs.

Management of the patient with disruptive vocalization

Disruptive vocalization (DV) is a common problem in the management of cognitively and physically impaired older people. This article reports the results of a consensus meeting convened to provide guidelines for clinicians and recommendations for researchers in this difficult and little-studied behavioral problem. DV arises largely in people with cognitive impairment and generally reflects an underlying need or discomfort. A variety of factors can precipitate and aggravate DV; the key to management is appropriate identification of all possible factors and development of an individualized treatment plan.

Measuring problem behaviors in dementia: developing a methodological agenda

As many as 90% of persons with dementing illness demonstrate problem behaviors that range from repetitive verbalizations, agitation, and wandering to verbal and physical aggression toward self and others. Reliable and accurate measurement of these behaviors is crucial for tracking illness progression; for monitoring the effects of pharmacologic and behavioral interventions; and for continued investigation into the correlates of caregiver stress, burden, and coping. However, there is no single, universally accepted measure or methodology for operationalizing problem behaviors, and variations in definition and measurement across studies complicate drawing meaningful conclusions about these behaviors. This article is an overview of five factors that have complicated accurate and dependable measurement of problem behaviors in dementia: the shifting domain of problem behaviors, slippage across research constructs, unexplored rater bias, scoring bias, and the absence of benchmarking studies. A methodological agenda is discussed for future investigations in this rapidly growing area of gerontological research.

Interventions for family caregivers of patients with Alzheimer's disease in community-based settings: items for consideration

There is a need for more rigorous evaluation research on existing services for Alzheimer's disease (AD; e.g., specialized day care, respite care, etc.). The needs, resources, and responses of rural caregivers, and the development, implementation, and evaluation of innovative services where they do not exist are of particular interest.

Bathing persons with dementia

In the care of persons with Alzheimer's disease and related disorders, bathing frequently poses a formidable challenge for caregivers. This article reports the results of a consensus conference on techniques to reduce disruptive behaviors during bathing, and to make the process less stressful for persons with dementia.

Perceived changes in adult family members' roles and responsibilities during critical illness

An exploratory design was used to study the effects of critical care hospitalization on family roles and responsibilities of adult family members and how these effects changed over time. A convenience sample of 52 subjects from pediatric, neonatal, surgical, medical, and cardiovascular intensive care units was used. Data were collected using an open-ended question contained in the Iowa ICU Family Scale (IIFS). Using qualitative techniques, seven themes were identified: (a) Pulling together, (b) Fragmentation of families, (c) Increased dependence, (d) Increased independence, (e) Increased responsibilities, (f) Change in routine, and (g) Change in feelings. These findings indicate that nurses need to implement family-centered interventions such as role supplementation programs or identification of support systems to decrease role strain and role overload in families during a crisis.

Use of standardized nursing diagnoses and interventions in long-term care

1. Standardized language for patient assessment, nursing diagnoses and interventions provide a common language for professionals in long-term care. 2. A comprehensive Nursing Interventions Classification (NIC) was first published in 1992 by the Iowa Intervention Project and the North American Nursing Diagnosis Association offers a comprehensive list of nursing diagnoses. 3. Most frequently used nursing diagnoses were: Self Care Deficit: Bathing/Hygiene, Self Care Deficit: Dressing/Grooming, Impaired Physical Mobility, Altered Thought Process, and Potential for Injury.

Infusing research into practice to promote quality care

This article describes the Iowa Model of Research in Practice, a heuristic model used at the University of Iowa Hospitals and Clinics for infusing research into practice to improve the quality of care. The components of the model are presented with examples. The impact of the model on patient, staff, and fiscal outcomes is delineated.

Emotional responses of family members during a critical care hospitalization

BACKGROUND: The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing interventions to assist family members in coping with a critical care hospitalization, accurate information about their emotional response to the situation is needed. OBJECTIVE: To examine emotional responses of family members and their descriptions of supportive behaviors of others during a critical care hospitalization. METHODS: An exploratory design was used to study 52 subjects with critically ill family members in the pediatric, neonatal, medical, surgical and cardiovascular intensive care units in a large tertiary care hospital. The subjects kept daily logs of their feelings and the supportive behaviors of others. Thematic analysis was used to identify major themes. RESULTS: Analysis revealed a broad range of powerful emotions throughout the intensive care unit stay. Negative and positive emotions such as despair and joy were sometimes identified by subjects within a 24-hour period. Although fear, worry, anger and exhaustion were dominant themes during the first 24 hours and when the family received bad news about the patient, there was no pattern of emotional response evident as the stay progressed. Some differences between subjects drawn from the medical and neonatal intensive care units were evident. CONCLUSIONS: The findings suggest that family members of critically ill patients experience deep emotional turmoil throughout the intensive care unit stay. Specific nursing interventions to promote adaptive coping are needed throughout the experience.

Emotional responses of family members during a critical care hospitalization

BACKGROUND

The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing interventions to assist family members in coping with a critical care hospitalization, accurate information about their emotional response to the situation is needed.

OBJECTIVE

To examine emotional responses of family members and their descriptions of supportive behaviors of others during a critical care hospitalization.

METHODS

An exploratory design was used to study 52 subjects with critically ill family members in the pediatric, neonatal, medical, surgical and cardiovascular intensive care units in a large tertiary care hospital. The subjects kept daily logs of their feelings and the supportive behaviors of others. Thematic analysis was used to identify major themes.

RESULTS

Analysis revealed a broad range of powerful emotions throughout the intensive care unit stay. Negative and positive emotions such as despair and joy were sometimes identified by subjects within a 24-hour period. Although fear, worry, anger and exhaustion were dominant themes during the first 24 hours and when the family received bad news about the patient, there was no pattern of emotional response evident as the stay progressed. Some differences between subjects drawn from the medical and neonatal intensive care units were evident.

CONCLUSIONS

The findings suggest that family members of critically ill patients experience deep emotional turmoil throughout the intensive care unit stay. Specific nursing interventions to promote adaptive coping are needed throughout the experience.

Displacement analysis of the temporomandibular condyle from magnetic resonance images

A technique was developed to investigate the condylar displacement of the human temporomandibular joint. Condylar displacement was analyzed from magnetic resonance images of the joint. Fourteen static images were obtained during incremental jaw closure. Landmarks were identified on the magnetic resonance images and reference points were digitized. The condylar displacement was calculated based on an optimization algorithm. The technique was proven to be reproducible based on two feasibility tests. The results provided quantitative descriptions of the condylar displacement as a function of a prescribed jaw movement. The displacement was characterized by a translation of an anatomical point on the condyle and a rotation of the mandible. The condylar displacement was 6 mm at a mouth opening of 17 mm. Maximum rotation of the mandible was 12.3 degrees C. The motion of the condyle produced by the mechanical guidance system used in this study may be characterized as a small forward translation at the beginning of jaw opening, followed by a combination of translation and rotation.

Behavioral responses of family members during critical illness

This articles describes the behavioral responses of adult family members to critical illness and how these responses change over the course of the hospitalization. A convenience sample of 52 family members of patients in intensive units completed the Iowa ICU Family Scale, a self-report tool measuring sleep, eating, activity, family role, and support behaviors. Scales were completed by family members each day during the first week and then weekly throughout the patient's ICU stay. Family members reported sleeping less with a poorer quality of sleep, less nutritional intake, an increased use of cigarettes, alcohol, and over-the-counter and prescription medications, and spending more time talking, visiting the patient, and waiting. Stress was highest at the time of the ICU admission, began to plateau at Day 6, and then dropped considerably by Day 28. These findings suggest that crisis intervention is important during the early phase of caring for critically ill patients and their family members.

Organizational and employee predictors of outcomes of long-stay nursing home residents

OBJECTIVE

Use three types of functional ability as predictors of nursing home patient outcomes.

DESIGN

Best-subsets regression analysis.

SETTING

10 nursing homes.

RESULTS

Initial functional ability was the most important predictor. Organizational variables such as workload, stress, and morale also explained some of the variance in patient outcomes. Characteristics of organizational structure predicted outcomes as well as employee self-reports and could be substituted for them without substantially reducing the explained variance.

CONCLUSION

Future research projects should explore the causal relationship between structure and outcomes.

Group functioning of a collaborative family research team

Collaborative research teams are an attractive means of conducting nursing research in the clinical setting because of the many opportunities that collaboration can supply. These opportunities include a chance to: (1) network with other nurses who have similar interests, (2) share knowledge and expertise for designing clinical studies that directly affect daily practice, (3) develop instruments, (4) write grant proposals, (5) collect and analyze data, and (6) prepare manuscripts for publication. The effectiveness of research teams, however, is strongly influenced by group functioning. This article describes the functioning of a collaborative family interventions research team of nursing faculty members and CNSs at a large Midwestern university setting. The formation of the group and membership characteristics are described, along with strategies used to identify the research focus and individual and group goals. Aspects related to the influence of the group on members and the internal operations of the group are also addressed. Future strategies to be explored will focus on the size of the group and joint authorship issues. The authors also set forth a number of recommendations for development of collaborative research groups.

Effects of child visitation in adult critical care units: a pilot study

OBJECTIVE

To examine the behavioral and emotional responses of the child and of the nonhospitalized adult family member (NHAFM) to facilitated child visitation in the critical care setting.

DESIGN

Quasi-experimental, posttreatment design.

SETTING

An adult surgical intensive care unit at a large Midwestern teaching hospital.

PARTICIPANTS

Twenty families participated in the study, 10 families in a restricted and 10 families in a facilitated visitation group. Each family unit had a child, an NHAFM, and a critically ill family member. In the control group the NHAFMs visited the patient in the customary routine, but children were restricted from visiting. After a 2-week waiting period a facilitated child visitation intervention was implemented for the experimental group.

OUTCOME MEASURES

The child completed measures on anxiety as measured by the Manifest Anxiety Scale and behavioral and emotional changes as measured by the Perceived Change Scale. The NHAFM completed measures on anxiety as measured by the State-Trait Anxiety Inventory and mood as measured by the Mood Adjective Check List. Family functioning, as measured by the Feetham Family Functioning Survey, and life event changes, as measured by the Life Event Scale, were examined as extraneous variables.

INTERVENTION

The Child Visitation Intervention encompassed systematic facilitation and supervision of children visiting a critically ill adult family member in a surgical intensive care unit and provision of emotional support before, during, and after visitation (the intervention protocol may be obtained from the investigators on request).

RESULTS

Children in the facilitated visitation group had a greater reduction (t = 4.0, df = 18, p = 0.0004) in negative behavioral and emotional changes as measured by the Child-Perceived Change Scale when compared with children in the restricted visitation group.

CONCLUSION

Facilitated child visitation may help children deal with the critical illness of an adult family member and deserves further study.

Precision of hyaline cartilage thickness measurements

Measurement of cartilage thickness in vivo is an important indicator of the status of a joint as the various degenerative and inflammatory arthritides directly affect the condition of the cartilage. In order to assess the precision of thickness measurements of hyaline articular cartilage, we undertook a pilot study using MR imaging, plain radiography, and ultrasonography (US). We measured the cartilage of the hip and knee joints in 10 persons (4 healthy volunteers and 6 patients). The joints in each patient were examined on two separate occasions using each modality. In the hips as well as the knee joints, the most precise measuring method was plain film radiography. For radiographs of the knees obtained in the standing position, the coefficient of variation was 6.5%; in the hips this figure was 6.34%. US of the knees and MR imaging of the hips were the second best modalities in the measurement of cartilage thickness. In addition, MR imaging enabled the most complete visualization of the joint cartilage.

Computed arthrotomography of the shoulder: comparison of examinations made with internal and external rotation of the humerus

We assessed the best positioning of the humerus for CT scans obtained after air-contrast shoulder arthrography by performing 54 examinations with both external and internal rotation of the humerus. Of the 30 abnormalities of the anterior portion of the labrum, 27 (90%) were identified on the scans obtained with the arm in internal rotation. The other three (10%) were shown best or solely on the scans obtained with the arm in external rotation. All 22 abnormalities of the anterior capsule were shown on the scans obtained with internal rotation. In no case were scans obtained in external rotation superior. Five posterior labral and capsule abnormalities were found; two of them were identified best or only on scans obtained with external rotation. The other three were shown equally well with the arm in either position. The results show that a modest (9%) increase in diagnostic yield can be expected when CT scans obtained with the arm in external rotation are added to studies performed solely with the arm internally rotated.

The effects of mental dysfunction on nursing home care

Many of the residents of nursing homes have mental health problems. These can be expected to affect the quantity of nursing care they require. Analysis of 285 nursing home residents, most of whom had moderate behavioral problems, reveals that their mental health characteristics can be summarized in terms of three factors: cognition, affect and aggressiveness. Cognitive deficits significantly increase the quantity of basic nursing services patients require. Negative affect increases the amount of psychosocial care received. The results of the analysis are interpreted as indicating that nursing home reimbursement systems should account for moderate as well as severe mental illness.

Adaptive histogram equalization in digital radiography of destructive skeletal lesions

Adaptive histogram equalization, an image-processing technique that distributes pixel values of an image uniformly throughout the gray scale, was applied to 28 plain radiographs of bone lesions, after they had been digitized. The non-equalized and equalized digital images were compared by two skeletal radiologists with respect to lesion margins, internal matrix, soft-tissue mass, cortical breakthrough, and periosteal reaction. Receiver operating characteristic (ROC) curves were constructed on the basis of the responses. Equalized images were superior to nonequalized images in determination of cortical breakthrough and presence or absence of periosteal reaction. ROC analysis showed no significant difference in determination of margins, matrix, or soft-tissue masses.

Magnetic resonance imaging of knee hyaline cartilage and intraarticular pathology

Injuries to the hyaline cartilage of the knee joint are difficult to diagnose without invasive techniques. Even though these defects may be the most important prognostic factors in assessing knee joint injury, they are usually not diagnosed until arthrotomy or arthroscopy. Once injuries to hyaline cartilage are found and/or treated, no technique exists to follow these over time. Plain radiographs, arthrograms, and even computed tomography fail to detail most hyaline cartilage defects. We used magnetic resonance imaging (MRI) to evaluate five fresh frozen cadaver limbs and 10 patients whose pathology was known from arthrotomy or arthroscopic examination. Using a 0.35 Tesla superconducting magnet and spin-echo imaging technique with a head coil, we found that intraarticular fluid or air helped to delineate hyaline cartilage pathology. The multiplane capability of MRI proved to be excellent in detailing small (3 mm or more) defects on the femoral condyles and patellar surface. Cruciate ligaments were best visualized on sagittal oblique projections while meniscal pathology was best seen on true sagittal and coronal projections. MRI shows great promise in providing a noninvasive technique of evaluating hyaline cartilage defects, their response to treatment, and detailed anatomical information about cruciate ligaments and menisci.