Technical assessment of resolution of handheld ultrasound devices and clinical implications

PURPOSE

Since handheld ultrasound devices are becoming increasingly ubiquitous, objective criteria to determine image quality are needed. We therefore conducted a comparison of objective quality measures and clinical performance.

MATERIAL AND METHODS

A comparison of handheld devices (Butterfly IQ+, Clarius HD, Clarius HD3, Philips Lumify, GE VScan Air) and workstations (GE Logiq E10, Toshiba Aplio 500) was performed using a phantom. As a comparison, clinical investigations were performed by two experienced ultrasonographers by measuring the resolution of anatomical structures in the liver, pancreas, and intestine in ten subjects.

RESULTS

Axial full width at half maximum resolution (FWHM) of 100µm phantom pins at depths between one and twelve cm ranged from 0.6-1.9mm without correlation to pin depth. Lateral FWHM resolution ranged from 1.3-8.7mm and was positively correlated with depth (r=0.6). Axial and lateral resolution differed between devices (p<0.001) with the lowest median lateral resolution observed in the E10 (5.4mm) and the lowest axial resolution (1.6mm) for the IQ+ device. Although devices showed no significant differences in most clinical applications, ultrasonographers were able to differentiate a median of two additional layers in the wall of the sigmoid colon and one additional structure in segmental portal fields (p<0.05) using cartwheel devices.

CONCLUSION

While handheld devices showed superior or similar performance in the phantom and routine measurements, workstations still provided superior clinical imaging and resolution of anatomical substructures, indicating a lack of objective measurements to evaluate clinical ultrasound devices.

Temperature profile and residual heat of monopolar laparoscopic and endoscopic dissection instruments

BACKGROUND

Endoscopic and laparoscopic electrosurgical devices (ED) are of great importance in modern medicine but can cause adverse events such as tissue injuries and burns from residual heat. While laparoscopic tools are well investigated, detailed insights about the temperature profile of endoscopic knives are lacking. Our aim is to investigate the temperature and the residual heat of laparoscopic and endoscopic monopolar instruments to increase the safety in handling ED.

METHODS

An infrared camera was used to measure the temperature of laparoscopic and endoscopic instruments during energy application and to determine the cooling time to below 50 °C at a porcine stomach. Different power levels and cutting intervals were studied to investigate their impact on the temperature profile.

RESULTS

During activation, the laparoscopic hook exceeded 120 °C regularly for an up to 10 mm shaft length. With regards to endoknives, only the Dual Tip Knife showed a shaft temperature of above 50 °C. The residual heat of the laparoscopic hook remained above 50 °C for at least 15 s after activation. Endoknives cooled to below 50 °C in 4 s. A higher power level and longer cutting duration significantly increased the shaft temperature and prolonged the cooling time (p < 0.001).

CONCLUSION

Residual heat and maximum temperature during energy application depend strongly on the chosen effect and cutting duration. To avoid potential injuries, the user should not touch any tissue with the laparoscopic hook for at least 15 s and with the endoknives for at least 4 s after energy application. As the shaft also heats up to over 120 °C, the user should be careful to avoid tissue contact during activation with the shaft. These results should be strongly considered for safety reasons when handling monopolar ED.

[Somatic and pharmacological nurse care in 2b-teams in Flanders: a cross-sectional explorative study]

In the context of the Belgian mental health care reform (project 107), 2b-teams provide care to people with a serious mental illness (smi), a population encountering regular somatic comorbidity and limited compliance with medication. Team composition and care provided by these teams is rather unclear.<br /> AIM: To consider the team composition and to focus on the nurses' role within Flemish 2b-teams. Also, seen from different disciplines involved, to determine the desired future nursing role.<br /> METHOD: A structured interview was used to discover team characteristics and fidelity to the flexible assertive community treatment (fact) model in 12 Flemish 2b-teams. With a digital survey containing 16 questions we explored the actual and desired nursing care, according to 151 nurses and medical physicians.<br /> RESULTS: Despite the difference in team size and composition, it was not found to be significant. Flemish team's fact model-fidelity was average. Actual care was restricted to psychosocial interventions. Regarding desired care, significant differences were found between physicians and nurses. Caregivers within outreach teams scored items significantly higher on desired care compared to actual care.<br /> CONCLUSION: We conclude that the team composition of Flemish 2b-team varies, with an average fact model fidelity. Team care is restricted to psychosocial interventions, while more somatic and nursing care is desired.

Effects of prolactin on signal transduction and gene expression: possible relevance for systemic lupus erythematosus

Receptors for prolactin (PRL-R) are expressed in normal leukocytes from rat and man. PRL signals through PRL-R associated Janus tyrosine kinase (Jak)-2 and signal transducers and activators of transcription (Stat). In addition, in human leukocytes PRL also activates the p38 MAP kinase pathway. PRL, at physiological concentrations, stimulates the expression of the interferon regulatory factor (IRF)-1 gene in rat spleen and bone marrow cells. In man, genes induced by PRL include several members of the 'suppressors of cytokine signaling' (SOCS) family and inducible nitric oxide synthase (iNOS; in mononuclear cells and in granulocytes) and IRF-1 (in granulocytes). Thus, in normal leukocytes, PRL induces the expression of several genes relevant to innate and acquired immune responses. Sex hormones, such as estrogen and PRL, have been implicated in the pathogenesis of murine and human SLE. Also defective signaling in leukocytes is a feature of the disease. What the origin is of aberrant signaling processes in SLE lymphocytes and how they relate to tolerance breakdown and immunopathology is still unknown. It is not unlikely that PRL is a player at some level. The exact contribution of PRL to immune responses in normal subjects and in SLE patients is not known. Further work should also indicate whether PRL might contribute to the onset or progression of the disease and assess the possible benefits of manipulating PRL concentrations in patients.

Palliative care. The nurse's role in helping families through the transition of "fading away"

Oncology nurses are finding themselves increasingly involved in providing palliative care. A foundational tenet of palliative care is that the entire family, not just the patient, is the unit of care. Although nursing literature on care of the family is growing, nursing approaches tend to be described in general terms. A recent study of families caring for a member with advanced cancer generated a theoretic scheme which indicated that the families' experience could be conceptualized as a transition: the transition of fading away. This theoretic scheme served as the foundation for identifying nursing approaches which could be helpful to families engaged in the transition. This paper expands on the nursing approaches so that nurses may be better prepared to help families through the transition of fading away.

The work of patients and spouses in managing advanced cancer at home

The purpose of this paper is to report the findings of a descriptive study which identified the resources used by patients with advanced cancer and their spouses to manage at home. Data were collected through semi-structured interviews with a sample of seven couples identified through two ambulatory clinics at a regional cancer institute. Participants were patients with advanced cancer, between the ages of 45 and 66, and their spouses. Interviews, conducted with each individual and with each couple, were audiotaped, transcribed, and subjected to qualitative analysis. Content analysis showed that patients and spouses utilized internal and external resources, and that external resources were either physical or interpersonal in nature. Conceptual analysis indicated that both patients and spouses dealt with facing either inevitable or uncertain death by engaging in various types of "work." Understanding the dimensions of such work has implications for health care professionals caring for patients and families in palliative care.