A Case-Control Study of Sonographic Maximum Ovarian Diameter as a Predictor of Ovarian Torsion in Emergency Department Females With Pelvic Pain.

BACKGROUND: Color and power Doppler ultrasound are commonly used in the evaluation of ovarian torsion but are unreliable. Because normal-sized ovaries are unlikely to cause torsion, maximum ovarian diameter (MOD) could theoretically be used as a screening test in the ED. Identification of MOD values below which torsion is unlikely would be of benefit to providers interpreting radiology department or point-of-care pelvic ultrasound. OBJECTIVES: The objective was to determine if sonographic MOD can be used as a screening tool to rule out torsion in selected patients. METHODS: Via a retrospective case-control study spanning a 14-year period, we examined the ultrasound characteristics of patients with torsion and age-matched controls, all presenting to the emergency department with lower abdominal pain and receiving a radiology department pelvic ultrasound for "rule-out torsion." Standardized data collection forms were utilized. Distributions of MOD were compared and sensitivity, specificity, and likelihood ratios were calculated for multiple cutoffs. RESULTS: We identified 92 cases of surgically confirmed ovarian torsion and selected 92 age-matched controls. In postmenarchal patients the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 3- and 5-cm MODs were 100% (96%-100%), 30% (20%-41%), 1.4 (1.3-1.7), and 0 and 91% (83%-97%), 92% (83%-97%), 11.2 (5.5-22.9), and 0.09 (0.04-0.19), respectively. The 5-cm MOD, however, excluded an additional 52 of 84 (62%) postmenarchal patients. CONCLUSIONS: A threshold MOD of 5 cm on pelvic ultrasound may be useful to rule out ovarian torsion in postmenarchal females presenting with lower abdominal and pelvic pain.

Phelgmasia Cerulea Dolens Diagnosed by Point-of-Care Ultrasound.

Phlegmasia cerulea dolens (PCD) is a rare entity that is associated with significant morbidity and mortality, including limb ischemia and pulmonary embolism. Point-of-care ultrasound (POCUS) can expedite the diagnosis, leading to earlier life- and limb-saving treatment. Although primarily used for assessing for the presence of deep venous thrombosis, in the appropriate clinical setting POCUS can also be used to diagnosis PCD as well as to distinguish between venous and arterial occlusion, which can lead to a difference in management. We present a case of phlegmasia cerulea dolens after mild trauma in a patient with an underlying hypercoagulability disorder diagnosed by an emergency physician using POCUS, which expedited treatment with catheter-directed thrombolytic therapy.

Mobile vitreous opacities on ocular ultrasonography are not always pathologic: a cross-sectional survey in an asymptomatic population.

BACKGROUND: Ultrasonography is often used in the evaluation of patients with ocular concerns; however, several pathologic conditions and even some age-related changes can have similar sonographic appearances. One approach that clinicians use is to assume that unilateral findings visible at normal gain are acute, whereas bilateral findings requiring high gain are chronic, especially in the elderly population. To date, no studies have systematically evaluated this assumption. OBJECTIVES: The objectives are to determine the prevalence of monocular and binocular mobile vitreous opacities (MVOs) in the vitreous chamber in an asymptomatic population at normal and high gain levels and to determine its prevalence with higher age stratifications. METHODS: We conducted a cross-sectional survey using 2-dimensional ultrasonography with a high-frequency transducer of 105 asymptomatic subjects aged 20-89 years and evaluated each subject's eyes for the presence of MVOs at both normal and high gain levels in progressive age stratifications. RESULTS: Ultrasonographic scans were obtained on 105 subjects. At normal gain levels, MVO was present in only 1 subject (0.95%; 95% confidence interval, 0.0%-5.0%). At high gain levels, MVO was present in 28.6% (30/105) of subjects. Of the subjects with MVO at high gain, 60% (18/30) had unilateral MVO. Mobile vitreous opacity was found more frequently with advancing age, being present in 23 subjects older than 59 years, compared with 7 subjects 59 years and younger (51.1% vs 11.7%, P < .001). CONCLUSIONS: Mobile vitreous opacity in the vitreous chamber visualized at high gain levels is relatively common and may not be pathologic, even if unilateral and occurring at a relatively young age.

Caregiving motivations and developmentally prompted transition for mothers of prematurely born infants.

Parenting transition is a process prompted by infant developmental changes and may be defined by motivations for caregiving and the goals they indicate. Qualitative exploration of neonatal and 1-year feeding experience of 22 mothers of very-low-birth-weight infants revealed 3 types of caregiving-related motivations-nurturing, relating, and shaping quality of life. The clusters of motivations differed between ages and across mothers, suggesting transition in parenting reflective of both infant development and maternal goals. Study with a larger sample is needed to examine change in caregiving motivations and their function in characterizing parenting transitions.

A continuing education program for hospital and public health nurses to guide families of very low birth-weight infants in caregiving.

Nurses have a critical role in family development of competencies for giving care to very low birth-weight infants, However, current information-based methods of preparation may be inadequate for competency development. This article describes a continuing education program designed to strengthen nurses' support of families in developing caregiving competencies through processes of guided participation. Program effectiveness was explored with: (1) a survey of participant and non-participant nurse satisfaction with family work and with organizational resources and practices; (2) a description of relationship and caregiving competencies for mothers who had and had not received guided participation; and (3) a review of mothers' reports of their experience either with or without guided participation. Organizational arrangements and mechanisms for establishing guided participation practice within an agency, including ongoing reflective supervision sessions, peer collaboration, and documentation of competency development, are discussed.

Development of relationship competencies through guided participation for mothers of preterm infants.

OBJECTIVE: To explore the effects of a guided participation (GP) intervention on mothers' development of competencies in relating to their preterm infants in neonatal intensive-care units. DESIGN: Mothers were enrolled in a randomized, longitudinal clinical trial to compare the effectiveness of GP with standard care teaching. Baseline data were collected when the infants were 29 weeks postconceptional age. The intervention (GP or standard care teaching) was administered, and relationship competencies were assessed through observation once per week for the next 6 weeks. SETTING: Two neonatal intensive-care units in the Midwest. PARTICIPANTS: A convenience sample of 16 mothers of low-birthweight infants, 8 in each group. INTERVENTIONS: GP of mothers in relating to their infants in the context of caregiving activities was compared with standard care teaching. RESULTS: Mothers in the GP group had expectations and intentions that were more attuned and adaptive to their infants' needs. In addition, the GP group was consistently higher in relationship competencies than the standard care teaching group. CONCLUSIONS: GP can effectively support mothers in developing relationships with their preterm infants in the context of neonatal intensive-care unit caregiving activities.

Effect of guided participation on feeding competencies of mothers and their premature infants.

The effect of guided participation (GP) on premature infant and maternal feeding competencies was examined, controlling for infant, maternal, and family conditions. Competencies were examined longitudinally and within age (1, 4, 8, and 12 months post-term age) for 42 mother-infant pairs randomly assigned to either GP or Standard Care (SC) groups. The hypothesized GP effect on competencies across infant age received support for infants (at 1 and 8 months) and for mothers (at 4 months). The hypothesized contribution of conditions was most strongly supported by the negative relationship between family poverty status and the two maternal competency variables. The hypothesized GP moderator effect on the relationship between depressive symptoms and maternal competency variables was supported for regulation of negative affect and behavior at 8 months. Despite study limitations in power and sensitivity to detect effects, findings indicate that further study of the GP intervention is merited.

Analysis of terminal events in 109 successive deaths in a Belgian intensive care unit.

OBJECTIVE: To determine the incidence of end-of-life decisions in intensive care unit (ICU) patients. DESIGN AND SETTING: Prospective data collection and questionnaire in a 31-bed medicosurgical ICU in a university hospital. PATIENTS AND PARTICIPANTS: All 109 ICU patients who died during a 3-month period (April-June 2001). Members of the ICU team were also invited to complete a questionnaire regarding the circumstances of each patient's death. Cardiopulmonary resuscitation was performed in 21 of the patients; other mechanisms leading to death were brain death (n=19), refractory shock (n=17), and refractory hypoxemia (n=2). The decision was taken in the remaining 50 patients to withdraw (n=43) or withhold (n=7) therapy. Questionnaires were completed for 68 patients, by physician and nurse in 40 cases, physician only in 20 cases, and nurse only in 8 cases. Questionnaires were obtained for 34 of 50 patients for whom a decision was made to limit therapy. RESULTS: Respondents generally felt that the decision was timely (n=28, 82%), 5 (15%) felt the decision was too late, and one (3%) that the decision was made too soon, before the family could be informed. CONCLUSIONS: Therapeutic limitations are frequent in patients dying in the ICU, with withdrawing more common than withholding life support. Generally members of the ICU staff were satisfied with the end-of-life decisions made.