Scientific basis for standardization of fetal head measurements by ultrasound: a reproducibility study.

OBJECTIVE: To compare the standard methods for ultrasound measurement of fetal head circumference (HC) and biparietal diameter (BPD) (outer-to-outer (BPDoo) vs outer-to-inner (BPDoi) caliper placement), and compare acquisition of these measurements in transthalamic (TT) vs transventricular (TV) planes. METHODS: This study utilized ultrasound images acquired from women participating in the Oxford arm of the INTERGROWTH-21(st) Project. In the first phase of the study, BPDoo and BPDoi were measured on stored images. In the second phase, real-time measurements of BPD, occipitofrontal diameter (OFD) and HC in TT and TV planes were obtained by pairs of sonographers. Reproducibility of measurements made by the same (intraobserver) and by different (interobserver) sonographers, as well as the reproducibility of caliper placement and measurements obtained in different planes, was assessed using Bland-Altman plots. RESULTS: In Phase I, we analyzed ultrasound images of 108 singleton fetuses. The mean intraobserver and interobserver differences were < 2% (1.34 mm) and the 95% limits of agreement were < 5% (3 mm) for both BPDoo and BPDoi. Neither method for measuring BPD showed consistently better reproducibility. In Phase II, we analyzed ultrasound images of 100 different singleton fetuses. The mean intraobserver and interobserver differences were < 1% (2.26 mm) and the 95% limits of agreement were < 8% (14.45 mm) for all fetal head measurements obtained in TV and TT planes. Neither plane for measuring fetal head showed consistently better reproducibility. Measurement of HC using the ellipse facility was as reproducible as HC calculated from BPD and OFD. OFD by itself was the least reproducible of all fetal head measurements. CONCLUSIONS: Measurements of BPDoi and BPDoo are equally reproducible; however, we believe BPDoo should be used in clinical practice as it allows fetal HC to be measured and compared with neonatal HC. For all head measurements, TV and TT planes provide equally reproducible values at any gestational age, and HC values are similar in both planes. Fetal head measurement in the TT plane is preferable as international standards in this plane are available; however, measurements in the TV plane can be plotted on the same standards. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

The created environment for physical assessment by case managers.

Goals of gerontological nursing include maximizing health and confronting functional impairments. The health of older adults is often fragile because of age-related change, complicated by chronic illnesses. Identification of changes in health status permits responsive care and consultation but requires proficiency in physical assessment. In 1995, research was conducted in Alberta, Canada, on registered nurse case managers' reported use of assessment skills. Nineteen continuing-care facilities in 1 of 17 provincial health regions participated (N = 189). After expert review and pilot testing, questionnaires were distributed to two independent groups: nurse administrators/staff development coordinators and case managers (response rate = 73%). Qualitative data were subjected to descriptive, interpretive, and pattern coding. Reported are factors constraining or facilitating physical assessment in continuing care. Neuman's concept of the created environment provided a factor-organizing framework. A holistic view of environment and data source triangulation increased confidence in the comprehensiveness and credibility of results.

Continuing care nurses' perceptions of need for physical assessment skills.

The purpose of this descriptive research was to identify the perceived learning needs of registered nurse case managers for physical assessment skills, their facility with computers, and barriers and supports to the enhancement and application of physical assessment by these caregivers in the work-place. Nineteen continuing care facilities in one Alberta Health Region participated. Using data source triangulation, two independent groups, case managers (n = 150) and nurse administrators or staff development officers (n = 39) responded to a questionnaire developed by the researchers. The case managers reported that skill in physical assessment was very important in their work, but current skill was inadequate to meet resident care needs. Both groups ranked the thorax and lungs, cardiovascular/peripheral vascular systems, and abdomen as the top three body systems or regions in terms of the case managers' learning needs. This research identified that for these case managers, upgrading skills in physical assessment was a continuing education priority and suggested computer-assisted instruction as a potential delivery method.

The chronic wound management decision tree: a tool for long-term care nurses.

Skin care and wound management are integral components of practice for nurses who care for frail, elderly, and chronically ill persons. However, "knowing which dressing to use and when to use it can be a mystery for those who lack the opportunity and time to study wound care and thoroughly evaluate the products." In our long-term care facility in Edmonton, it was not uncommon to find that treatment decisions were inconsistent, fluctuating with individual nurses' and physicians' knowledge, experience, training, and preferences. Although the skin problems of residents in our long-term care facility were few in number, we believed that we could provide better wound care. Our goal was to develop a chronic wound care protocol to assist nursing staff in making consistent, correct wound care choices. The Chronic Wound Management Decision Tree is the result of our efforts. In this article we review the development, use, implementation and evaluation of this tool in our long-term care organization.

Systemic side-effects of extradural steroids.

The use of extradural (epidural) steroids in the management of selected cases of lumbosciatic syndrome is well known. This paper reports the appearance of systemic side-effects in four cases after each had received an injection of 6-10 ml of methylprednisolone and 0.25% bupivacaine into the extradural space at the site nearest to the affected nerve roots.

The interaction of halothane and pancuronium bromide. A study in dogs.

The interaction of halothane and pancuronium is demonstrated in the dog tibialis anterior-sciatic nerve preparation. The results show a dose related effect of halothane on the recovery index and the 50% recovery times. These results are compared to other reports and possible mechanisms are discussed.