Conhecimento e prática de enfermeiros sobre protocolos de segurança na tomografia computadorizada / Nurses' knowledge and practice toward computed tomography safety protocols

RESUMO Objetivo avaliar o conhecimento e as práticas de enfermeiros quanto às recomendações de segurança para realização de tomografias computadorizadas. Métodos estudo transversal utilizando amostra de conveniência de dois hospitais públicos. Foi elaborado um questionário para avaliar as características sociodemográficas, conhecimento e práticas dos enfermeiros. Realizou-se análise descritiva para avaliar as características, e as correlações foram avaliadas através da correlação de Spearman. Os testes U de Mann-Whitney e H de Kruskal-Wallis foram usados para comparar as médias das pontuações de conhecimento e práticas. Resultados a maioria dos participantes era do sexo feminino (91,6%), de 20 a 29 anos (57,3%), e tinha a graduação como seu nível de formação (74%). Níveis de conhecimento e prática foram de 58% e 78,9%, respectivamente. Houve correlação positiva entre o conhecimento e a prática nos enfermeiros (r=0,684, p<0,001), mas, sem diferenças estatisticamente significativas entre características sociodemográficas e a pontuação de conhecimento ou práticas. Conclusão enfermeiros mostraram um nível adequado em sua prática do preparo seguro para tomografias computadorizadas, embora seu nível de conhecimento tenha se mostrado deficiente. Contribuições para a prática esse estudo demonstra a importância do conhecimento enquanto guia da prática de enfermagem rumo a um uso melhor das medidas de segurança para tomografias computadorizadas.

ABSTRACT Objective to assess nurses' knowledge and practice toward computed tomography scan safety guidelines. Methods a cross-sectional study was conducted using a convenience sample of 131 nurses from two government hospitals. Self-designed questionnaire was used to assess nurses' sociodemographic characteristics, knowledge, and practice. Descriptive analysis was performed to evaluate characteristics, correlations were evaluated using Spearman's rank correlation coefficient, and the Mann-Whitney U and the Kruskal-Wallis H tests were used to compare the mean ranks of knowledge and practice scores. Results most respondents were female (91.6%), were aged 20-29 years (57.3%), and had bachelor's degrees (74%). Knowledge and practice levels were 58% and 78.9% respectively. A positive correlation between knowledge and practice was observed among nurses (r=0.684, p<0.001). No statistically significant differences were observed between sociodemographic characteristics and knowledge and practice scores. Conclusion nurses showed adequate level of practice toward computed tomography scan safety preparations while their knowledge level was deficient. Contributions to practice this study informs the importance of knowledge in guiding nursing practice toward appropriate computed tomography scan safety measures.

CT Image Features of the FBP Reconstruction Algorithm in the Evaluation of Fasting Blood Sugar Level of Diabetic Pulmonary Tuberculosis Patients and Early Diet Nursing.

The study was aimed at exploring the application value of the CT image based on a filtered back projection (FBP) algorithm in the diagnosis of patients with diabetes complicated with tuberculosis and at analyzing the influence of dietary nursing on patients with diabetes complicated with tuberculosis. In this study, the FBP algorithm was used to optimize CT images to effectively obtain reconstructed ROI images. Then, the deviation from measurement values of reconstructed images at different pixel levels was analyzed. 138 patients with diabetes complicated with tuberculosis were selected as research subjects to compare the number of lung segments involved and the CT imaging manifestations at different fasting glucose levels. All patients were divided into the control group (routine drug treatment) and observation group (diet intervention on the basis of drug treatment) by random number table method, and the effect of different nursing methods on the improvement of patients' clinical symptoms was discussed. The results showed that the distance measurement value decreased with the increase in pixel level, there was no significant difference in the number of lung segments involved in patients with different fasting glucose levels (P > 0.05), and there were statistically significant differences in the incidence of segmental lobar shadow, bronchial air sign, wall-less cavity, thick-walled cavity, pulmonary multiple cavity, and bronchial tuberculosis in patients with different fasting glucose levels (P < 0.05). Compared with the control group, 2 h postprandial blood glucose level in the observation group was significantly improved (P < 0.05), there was a statistical significance in the number with reduced pleural effusion and the number with reduced tuberculosis foci in the two groups (P < 0.05), and the level of hemoglobin in the observation group was 7.1 ± 1.26, significantly lower than that in the control group (8.91 ± 2.03, P < 0.05). It suggested that the changes of CT images based on the FBP reconstruction algorithm were correlated with fasting blood glucose level. Personalized diet nursing intervention can improve the clinical symptoms of patients, which provides a reference for the clinical diagnosis and treatment of patients with diabetes complicated with tuberculosis.

Application of Computed Tomography Imaging in Diagnosis of Endocrine Nerve of Gastric Cancer and Nursing Intervention Effect.

In this article, some parameters and characteristics of computed tomography (CT) images in patients with gastric cancer are analyzed and the application of CT images in the diagnosis of gastric cancer endocrine nerves and the impact of nursing intervention on the quality and mental state of CT images of patients with gastric cancer are discussed. First, all patients were scanned with CT, and the CT values of the normal stomach wall and all lesions at different single-energy levels were recorded separately. Second, the improved back propagation network model was applied to realize the diagnosis of gastric cancer through the analysis of various features of CT images. The effect of nursing intervention on the image quality and mental state of CT imaging of patients with gastric cancer was studied. The results show that the energy spectrum curve of CT images and the improved back propagation network model are helpful for the initial diagnosis and identification of gastric cancer. Nursing intervention has a good influence on the clinical examination, image diagnosis, and psychological state of patients with gastric cancer, and it is easy for patients to undergo image diagnosis and examination according to correct operating procedures.

Lung Cancer Screening: Implementation of and Barriers to a Nurse Practitioner-Led Program.

Lung cancer accounts for more American deaths annually than any other cancer, and the survival rate is low among those diagnosed with advanced-stage disease. Screening with low-dose computed tomography (CT) can help to reduce mortality. CT screening for lung cancer should be performed in the context of a comprehensive screening program, rather than as a single isolated test. The addition of the nurse practitioner role is instrumental in creating a lung cancer screening program that may increase patient satisfaction and that meets regulatory criteria.

Saberes e experiências de clientes sobre o exame de tomografia computadorizada desvelados no diálogo com a enfermeira

O estudo centrou-se nos saberes e experiências de clientes sobre o exame de tomografia computadorizada (TC). A Enfermagem vem buscando qualificação na área radiológica,direcionada ao atendimento a clientes que realizam procedimentos diagnósticos e terapêuticos. Entretanto, o quantitativo de exames diários e o curto espaço de interação com os clientes são fatores que colaboram para que nem todas as orientações necessárias sejam contempladas. Quando ocorrem, são em geral com o intuito de transmitir informações sobre o que os clientes podem ou não fazer e como devem se comportar antes, durante e após o procedimento. Pautam-se em modelo de educação em saúde que se orienta em pedagogia vertical, que não contempla as expectativas dos clientes. Conhecer os saberes e experiências prévias dos clientes sobre o exame se faz necessário, permitindo a educação em saúde dialógica, no intento de mantê-los informados, diminuindo seu estresse e ansiedade, tornando os mais participativos e seguros para o procedimento. Os objetivos são: descrever saberes e experiências de clientes sobre a realização do exame de TC; discutir demandas de conhecimento e os cuidados necessários à sua realização; e construir material educativo como tecnologia de enfermagem voltada a tais cuidados, tendo em conta as mencionadas demandas. A prática dialógica freiriana foi o eixo teórico que sustentou o desenvolvimento da educação em saúde junto ao cliente. Pesquisa Convergente-Assistencial (PCA), realizada no setor deTC de um hospital federal terciário, localizado no Rio de Janeiro, com a participação de 23clientes adultos, 12 homens e 11 mulheres. A produção de dados foi realizada em seis etapas subsequentes e inter-relacionada, em dois encontros individuais, com uso da técnica de entrevista semiestruturada, com auxílio de roteiro, seguida de discussão. Aplicada a técnica de análise de conteúdo temática...

The study focused on knowledge and customer experience on computed tomography (CT).The nursing has been seeking qualification in radiological area, directed to the customerservice who perform diagnostic and therapeutic procedures. However, the amount of dailytests and the short interaction with customers are factors that contribute to that not all thenecessary guidelines are contemplated. When they occur, they are generally in order toconvey information about what customers can and can not do and how to behave before,during and after the procedure. are driven in health education model that is oriented in avertical pedagogy that does not address the customer expectations. Knowing the knowledgeand customer previous experience on the exam is required, allowing education in dialogichealth, in an attempt to keep them informed, reducing your stress and anxiety, making themmore participatory and safe for the procedure. The objectives are: describe knowledge andcustomer experiences on completing the CT scan; discuss demands of knowledge and carenecessary for their implementation; educational material and build as nursing technologydirected to such care, taking into account the above mentioned demands. The Freirian dialogicpractice was the theoretical axis that supported the development of health education with theclient. Convergent-Care Research (PCA), held in the TC sector of a tertiary federal hospitallocated in Rio de Janeiro, with the participation of 23 adult clients, 12 men and 11 women.The production data was performed in six subsequent steps and interrelated in two individualmeetings with use of semi-structured interview technique, script support, followed bydiscussion. Applied to thematic content analysis technique...

Update of clinical practice guidelines for brain death determination in an academic heath center.

UNLABELLED: Brain death (BD) is determined after a patient has sustained some form of a catastrophic neurologic injury that results in an irreversible loss of cerebral and brain steam function. Variability is caused by the small number of patients who progress to BD annually causing a lack of opportunity for physicians and healthcare staff to stay competent in performing the examination. BACKGROUND: The current University of Cincinnati Medical Center policy on BD had not been updated since publication of the 2010 American Academy of Neurology guidelines on this subject. The diagnosis of BD in the medical community is an acceptable medical diagnosis, but the examination is difficult to perform, and explaining this diagnosis to a family can be challenging related to the emotions involved with discussing end of life. The goal of updating the current policy was to decrease variability in testing through consistency of practice among clinicians performing the examination. METHODS: An integrative review of the evidence-based literature was conducted to identify articles discussing both BD confirmation and secondary confirmatory testing. Using this integrative review, results from hospital-based chart reviews, and targeted provider surveys, a policy update was completed. The bedside medical clinicians were provided this policy with evidence-based guidelines regarding performance of the clinical examination and confirmatory testing needed to diagnose BD and then communicate this diagnosis to the family. RESULTS: The current hospital policy lacked two important components of any BD policy: (a) the apnea test techniques and (b) guidance regarding secondary confirmatory testing. Both components were added during revision of the policy. Implementation of the new policy occurred through computer-based training that incorporated both didactic education of the updates and a video demonstration of a BD examination. DISCUSSION: A better defined policy for determining BD is essential. In addition, the implementation and quality assurance elements of the policy are necessary for efficiency and clinical decision making. By updating the policy within the University of Cincinnati Medical Center, the clinicians have been equipped with the latest evidence to perform the clinical examination for diagnosis of BD and then appropriately communicate this diagnosis to the family.

How does semi-automated computer-derived CT measure of breast density compare with subjective assessments to assess mean glandular breast density, in patients with breast cancer?

OBJECTIVES: (a) To compare radiologists' breast mammographic density readings with CT subjective measures. (b) To correlate computer-derived measurement of CT density with subjective assessments. (c) To evaluate density distributions in this cohort of patients with breast cancer. METHODS: A retrospective review of mammograms and CT scans in 77 patients with breast cancer obtained within 1 year of each other was performed. Two radiologists independently reviewed both CT and mammograms and classified each case into four categories as defined by the breast imaging-reporting and data system of the American College of Radiology. Inter-reader agreements were obtained for both mammographic and CT density subjective evaluations by using the Cohen-weighted kappa statistic and Spearman correlation. The semi-automated computer-derived measurement of breast density was correlated with visual measurements. RESULTS: Inter-reader agreements were lower for subjective CT density grades than those for mammographic readings 0.428 [confidence interval (CI), 0.24-0.89] vs 0.571 (CI, 0.35-0.76). There was moderately good correlation between subjective CT density grades and the mammographic density grades for both readers (0.760 for Reader 1 and 0.913 for Reader 2). The semi-automated CT density measurement correlated well with the subjective assessments, with complete agreement of the density grades in 84.9% of patients and only one level difference in the rest. CONCLUSIONS: Semi-automated CT density measurements in the evaluation of breast density correlated well with subjective mammographic density measurement. ADVANCES IN KNOWLEDGE: There is good correlation between CT and mammographic density, but further studies are needed on how to incorporate semi-automated CT breast density measurement in the risk stratification of patients.

Cardiac diagnostic testing: what bedside nurses need to know.

Coronary artery disease affects more than 385000 persons annually and continues to be a leading cause of death in the United States. Recently, the number of available noninvasive cardiac diagnostic tests has increased substantially. Nurses should be knowledgeable about available noninvasive cardiac diagnostic testing. The common noninvasive cardiac diagnostic testing procedures used to diagnose coronary heart disease are transthoracic echocardiography, stress testing (exercise, pharmacological, and nuclear), multidetector computed tomography, coronary artery calcium scoring (with electron beam computed tomography or computed tomographic angiography), and cardiac magnetic resonance imaging. Objectives include (1) describing available methods for noninvasive assessment of coronary artery disease, (2) identifying which populations each test is most appropriate for, (3) discussing advantages and limitations of each method of testing, (4) identifying nursing considerations when caring for patients undergoing various methods of testing, and (5) describing outcome findings of various methods.

Changing practice to prevent contrast-induced nephropathy.

Based on updated evidence, a radiology nurse systematically engaged a multidisciplinary staff in testing a protocol to prevent contrast-induced nephropathy related to computed tomography. In a quality improvement project, the protocol combined preprocedure oral hydration with postprocedure intravenous saline. This protocol safely improved kidney function, reduced postprocedure time, and decreased annual cost. By applying theory, being persistent, presenting sound evidence, and unifying the team, one concerned staff nurse profoundly affected patient care and policy in an entire medical center.

Retrograde venous bullet embolism after thoracic gunshot / Embolia balistica venosa retrograda apos ferimento toracico por arma de fogo

Bullet embolism is a rare complication of penetrating gunshots. We present a case of a 24-year-old man with a gunshot wound in the left scapular area, with no exit wound. Abdominal X-rays and a computed tomography (CT) scan suggested that the bullet was located within the intra-abdominal topography (intrahepatic), but laparotomy revealed no intra-abdominal injuries. After surgery, a sequential CT scan showed that the bullet had migrated to the right internal iliac vein (IIV). Venography confirmed the diagnosis of right IIV embolism and the decision was taken to attempt snare retrieval of the bullet, which was unsuccessful. It was therefore decided to leave the missile impacted inside the right IIV and the patient was put on oral anticoagulation. The patient recovered and was event free at 6 months' follow up.

Embolia balística é uma complicação rara de ferimentos por arma de fogo. Apresentamos um caso de um homem de 24 anos, vítima de um ferimento por arma de fogo em hemitórax posterior esquerdo (região escapular), sem orifício de saída. Radiografias e tomografia computadorizada do abdome evidenciaram um projétil em topografia intra-abdominal (intra-hepática); no entanto, a laparotomia exploradora demonstrou ausência de lesões intra-abdominais. Após a cirurgia, novo exame tomográfico revelou a migração da bala para a região da veia ilíaca interna (VII) direita. Realizada uma flebografia, esta confirmou a migração do projétil para a VII direita; tentou-se retirar o projétil durante o procedimento, sem sucesso. Optou-se, então, por deixá-la impactada na VII direita e manter o paciente em anticoagulação oral. O paciente evoluiu sem intercorrências até o sexto mês de seguimento.

Feasibility of flat panel detector computed tomography for position assessment of external ventricular drainage.

BACKGROUND AND PURPOSE: New angiographic devices with flat panel detectors allow cross-sectional imaging within the angiographic suite. In patients receiving external ventricular drainage (EVD) to manage hydrocephalus following subarachnoid haemorrhage (SAH), these may help evaluating the position of an EVD without moving the patient to a conventional computed tomography (CT) scanner. It could facilitate patients' management in a life-threatening status. This study therefore compares conventional CT with post-interventional flat panel detector angiographic CT (FDCT) referring to the determinability of an accurate EVD position. MATERIAL AND METHODS: Twenty patients with SAH received FDCT and conventional CT for primary assessment after EVD insertion. Three single-blinded raters compared both modalities and evaluated the image sufficiency for determining the EVD position, EVD tip, intracranial course and whether a contorted drainage tube could be detected. RESULTS: FDCT was sufficient to detect a correct EVD position in 82.5% of the cases vs. 100% in conventional CT. Regarding the EVD tip, FDCT delivered at least 'good' results in 82.5% vs. 95% in conventional CT data. Determining the EVD intracranial course, FDCT provided at least 'good' data in 92.5% vs. 100% in conventional CT. For detecting tube contortion, FDCT provided at least 'good' results in 70% vs. 98% in conventional CT. CONCLUSIONS: FDCT is a promising method to determine the correct position of an EVD in patients with SAH. Following a neuroradiological intervention, it facilitates the patients' management and renders additional transfers to conventional CT unnecessary in the majority of cases.

Oral contrast omission in the computed tomographic evaluation of blunt abdominal trauma: a literature review.

The purpose of this review is to examine existing research on oral contrast administrating as it pertains to the computed tomographic (CT) evaluation of blunt abdominal trauma, as well as to determine the necessity of oral contrast as part of a CT scanning universal protocol. Many hospitals routinely administer both oral and intravenous contrast prior to abdominal CT scan. There have been found to be numerous disadvantages and risks associated with oral contrast administration prior to CT scan. There has been a shift in many hospitals over the years from traditional CT scanners to multidetector row helical scanners, which allow for thinner collimation and higher spatial resolution. With the advances in technology, from single detector row to multidetector row helical CT scanners, the question whether oral contrast is necessary, useful, or dangerous presents itself. There is a significant lack of research on this topic over the past 10 years. All of the studies referenced support no longer administering oral contrast for the initial evaluation of the patient with blunt abdominal trauma. However, the findings of the studies cited in this article are based on small sample sizes and low incidences of solid organ, bowel, or mesenteric injuries. The current level of available research has significant limitations to support a recommendation to eliminate the administration of oral contrast before obtaining the initial CT scanning for blunt abdominal trauma. Further research is necessary before any conclusion or practice change can be made.

Radiation exposure and diagnostic imaging.

PURPOSE: The purpose of this article is to increase clinician awareness of current radiation exposures of diagnostic testing, discuss current practice patterns, and suggest strategies to address issues at the systems level, institution level, and the healthcare provider level. DATA SOURCES: Evidence-based literature including interdisciplinary peer-reviewed articles in the biological and health-related fields. CONCLUSIONS: Radiation exposure related to diagnostic testing is often higher than anticipated for both the clinician and the patient. Strategies to address radiation exposure need to be implemented at many different levels in the system. Best practice initiatives are surfacing and will require a team approach for success. IMPLICATIONS FOR PRACTICE: Nurse practitioners need to be aware of the benefits and risks of diagnostic testing involving radiation exposure. Patients should also be informed of potential risks and benefits. Alternative imaging should be considered and repetitive testing should be monitored closely.

Radiology nursing.

Radiology nursing is a relatively new field in which nurses can use multiple skills in caring for adult and pediatric patients. The authors present an overview of the role nurses play in interventional radiology, nuclear medicine, ultrasound, magnetic resonance imaging, computed tomography, and mammography. In addition, information about the professional affiliations and certification in the American Radiological Nurses Association is provided.