Frequency of use and acceptability of clinical prediction rules for pulmonary embolism among Swiss general internal medicine residents.

INTRODUCTION: Whether clinical prediction rules for pulmonary embolism are accepted and used among general internal medicine residents remains uncertain. We therefore evaluated the frequency of use and acceptability of the Revised Geneva Score (RGS) and the Pulmonary Embolism Severity Index (PESI), and explored which factors were associated with rule use. MATERIALS/METHODS: In an online survey among general internal medicine residents from 10 Swiss hospitals, we assessed rule acceptability using the Ottawa Acceptability of Decision Rules Instrument (OADRI) and explored the association between physician and training-related factors and rule use using mixed logistic regression models. RESULTS: The response rate was 50.4% (433/859). Overall, 61% and 36% of the residents reported that they always or regularly use the RGS and the PESI, respectively. The mean overall OADRI score was 4.3 (scale 0-6) for the RGS and 4.1 for the PESI, indicating a good acceptability. Rule acceptability (odds ratio [OR] 6.19 per point, 95% confidence interval [CI] 3.64-10.51), prior training in emergency medicine (OR 5.14, CI 2.20-12.01), and availability of internal guidelines recommending RGS use (OR 4.25, CI 2.15-8.43) were associated with RGS use. Rule acceptability (OR 6.43 per point, CI 4.17-9.92) and rule taught at medical school (OR 2.06, CI 1.24-3.43) were associated with PESI use. CONCLUSIONS: The RGS was more frequently used than the PESI. Both rules were considered acceptable. Rule acceptability, prior training in emergency medicine, availability of internal guidelines, and rule taught at medical school were associated with rule use and represent potential targets for quality improvement interventions.

Movement analysis in the early detection of newborns at risk for developing spasticity due to infantile cerebral palsy.

In order to limit the consequences of infantile cerebral palsy (ICP), physiotherapy should start as early as possible. This requires that infants at risk are detected at the earliest age possible. Today, diagnosis is based on visual observation by physicians and as such is influenced by subjective impressions. Objective methods, quantifying the pathological deviation from normal spontaneous motor activity would be preferable as they, for example, allow an inter- and intra-individual comparison of movement. In this paper we have developed a methodology that allows the 3-dimensional acquisition of unconstrained movement in newborn babies, using a motion analysis system. From the recorded movement data we have extracted 53 quantitative parameters that describe the differences between healthy and affected participants. Considered individually, each of these parameters does not permit a conclusive statement to be made as to whether or not the patient is at risk. Cluster analysis based on Euclidian distances therefore has been used to find an optimal combination of eight parameters. The optimal combination has been subsequently applied to organize the participants' movement into preferably homogeneous classes labelled "healthy" or "at risk". Classification was performed utilising quadratic discriminant analysis. The methodology presented allows a reliable discrimination between healthy and affected participants. Overall detection rate reached 73%. This value is expected to rise with increasing patient and norm collective database size.

Ultrasound findings in follow-up investigations in a case of aspartoacylase deficiency (canavan disease).

Aspartoacylase deficiency is a neurodegenerative disease which typically starts in the first months of life with muscular hypotonia and developmental standstill. One of the first diagnostic procedures in this situation is an ultrasound of the brain. There is little information available about sonographic changes in Canavan disease. We present for the first time an ultrasound follow-up in a proven case of aspartoacylase deficiency from 3 weeks to 22 months. High echogenicity of the white matter was present in the neonatal period. Additional sonographic phenomena resulting in a characteristic pattern were shown in further investigations. The distinctive sonomorphology is compared to a few other cases in the literature. The correlation to the neuropathological course of the white matter changes is discussed. Recognition of the sonographic features in addition to the clinical presentation may contribute to an effective biochemical work-up.

Clean versus sterile: a review of the literature.

To use clean or to use sterile is a question that is posed every day in clinical practice. While this review of the literature can not definitively answer the question, it does provide insight for ET nurses and other specialists who include wound care or urinary continence in their clinical practice.

Low profile gastrostomy devices.

Many styles of gastrostomy tubes have been developed and used over the years by patients requiring long-term enteral feedings. As an alternative to the use of the traditional gastrostomy tube, the low profile gastrostomy device (LPGD) was introduced in the mid-1980s. The purpose of this article is to provide an historical overview of gastrostomy tubes and the LPGD. The authors will highlight advantages and limitations of the two main types of LPGDs. Teaching guidelines are included. Nurses who possess a strong knowledge base on the latest trends in low profile gastrostomy devices will be better prepared to educate patients, family members, and caregivers.

Using the nursing process to solve a problem: post-op tape blisters.

ET nursing consultation was requested for the treatment of ten cases of tape blisters within six months, the majority of which were post-op following hip surgery. When the ET nursing staff was asked to develop a standard treatment protocol for these blisters, they used the nursing process. They identified the problem, assessed the situation, planned and implemented a response, and evaluated the results in an ongoing manner. It was then theorized that lack of "stretch" in the tape might be causing the tape blisters. After five stretch tapes were assessed for ease of removing the paper backing, handling, application, flexibility, and adhesion, one tape was preferred by the operating room and nursing unit staffs and was put into routine use in October 1992. No further blisters have been noted since this change was made. By using the nursing process, the authors ultimately eliminated post-op tape blisters in the facility.

When is a pressure ulcer not a pressure ulcer? ... external pressure versus internal pressure.

This case study presents a nontraditional explanation for recurring and difficult to heal pressure ulcers: internal pressure rather than external pressure. The authors are hopeful that this discussion will assist colleagues in recognizing this alternative diagnosis.