A vision of ethics in efficient occupational healthcare.

BACKGROUND:: Occupational healthcare is nowadays more and more regulated by economic demands of gain and efficiency. AIM AND RESEARCH QUESTIONS:: The aim of this study is to reach a new understanding of ethics in occupational healthcare by uncovering this from occupational healthcare nurses' own views. The research questions are as follows: (1) What is the core of an ethical value base in occupational healthcare? (2) What does it mean for occupational healthcare nurses to fulfill their ethical value base in occupational healthcare? RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT:: The study uses a hermeneutical approach. The context of the study is occupational healthcare. The material was collected through interviews with four occupational healthcare nurses in Finland. The texts were interpreted through hermeneutical reading. ETHICAL CONSIDERATIONS:: The data storage, study participation, and data handling for research purposes were approved by the participants when they provided their informed consent. FINDINGS:: The study revealed that the core of ethical values in occupational healthcare is something universal that concerns justice, honesty, and faithfulness. To fulfill the ethical value base means to continuously strive toward the inner core of love and bravely choose to listen to the this core in the name of the client and the universal good even if it involves a struggle or a sacrifice. DISCUSSION:: The ethical value base is not primarily tied to profession but is something that is general and universal. Nor do ethics and the implementation of ethical values stand in opposition to, for example, external values such as demands for efficiency and economic gain. However, ethics may promote efficiency. CONCLUSION:: The fulfillment of nurses' ethical value base in occupational healthcare requires that ethics first and foremost is allowed to enter the leadership and is prioritized on a leadership level. Creating caring cultures that encourage openness and support ethical discussions is fundamental.

Asymmetric nasal mucosal thickening in healthy dogs consistent with the nasal cycle as demonstrated by MRI and CT.

The nasal cycle is a physiological phenomenon that causes regular cyclical congestion and decongestion of the venous sinusoids lining the nasal mucosa. The purpose of this prospective study was to describe magnetic resonance imaging (MRI) and computed tomographic (CT) features of the normal nasal cycle in a group of dogs. Five dogs were recruited that met the following criteria: 8 to 15 months old, nonbrachiocephalic breed, no clinical signs or history of nasal disease, and undergoing anesthesia for problems unrelated to the nasal cavity. Nasal MRI (n = 5) and CT scans (pre- and postcontrast, n = 5) were acquired. Images were evaluated subjectively by two board-certified radiologists and objectively by a diagnostic imaging intern using regions of interest placed on each side of the nasal cavity. Findings were compared using Cohen's kappa coefficient and Students t-test on log-transformed data. All dogs showed diffuse unilateral mucosal thickening of the rostral part of the nasal cavity in both MRI and CT studies. This mucosal thickening shifted sides between examinations in three dogs. Changes appeared most marked on T2-weighted scans. No asymmetric mucosal changes were seen in the mucosa of the ethmoturbinates, vomer-nasal septum, hard palate or the frontal sinuses in any patient on MRI or CT. Computed tomographic contrast enhancement of the thickened mucosa was not statistically significant (P-value < 0.08). In conclusion, the normal nasal cycle may cause asymmetrical mucosal changes in the rostral part of the nasal cavity that mimic MRI and CT characteristics previously reported for inflammatory disease in dogs.

The sonographic evaluation of lymph nodes.

Ultrasound can be used to detect and evaluate both normal and abnormal lymph nodes, as well as aid in biopsy sampling procedures, an important part of staging procedures in cancer patients. Several parameters can be evaluated using ultrasound; lymph node size, margins, echogenicity, echopattern (echotexture), acoustic transmission, presence and distribution of vascular flow, and vascular flow indices. The most diagnostically helpful include the short/long axis ratio of the lymph node, the pattern of distribution of the blood vessels within the lymph node, and to some extent the resistive and pulsatility indices. This review discusses the use of ultrasound for detecting, evaluating, and sampling peripheral, abdominal and thoracic lymph nodes in small animals.

Comparison of B-mode and Doppler ultrasonographic findings with histologic features of benign and malignant superficial lymph nodes in dogs.

OBJECTIVE: To compare and correlate B-mode and color Doppler ultrasonographic characteristics with histopathologic findings of benign and malignant superficial lymph nodes in dogs. STUDY POPULATION: 50 superficial lymph nodes that were normal, abnormally large on physical examination, or represented regional lymph nodes draining an area of suspected primary malignancy in 30 dogs. PROCEDURES: Before excision, lymph nodes were evaluated via B-mode and color Doppler ultrasonography to assess size, echogenicity, presence of a hilus, acoustic transmission, and vascular flow. Formalin-fixed, paraffin-embedded tissue sections of excised lymph nodes were stained with H&E and examined for the presence and extent of necrosis, fibrosis, fat, metastases, and tissue heterogeneity. To assess vascularity, the number and distribution of vessels stained by the Verhoeff van Gieson technique were recorded. RESULTS: In superficial lymph nodes, a varied echogenicity corresponded to tissue heterogeneity. The ultrasonographic detection of a hilus was associated with the presence of fibrous tissue, fat, or both in the hilar region. Acoustic enhancement corresponded to presence of areas of intranodal necrosis. There was significant correlation between both the distribution and the number of vessels detected via ultrasonography and that detected by histopathology. The amount of flow estimated via ultrasonography was typically higher than that estimated via histologic examination. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that histopathologic changes in canine lymph nodes have associated ultrasonographic changes and suggest that lymph node ultrasonography has an important role in the evaluation of lymph nodes in dogs in general and in dogs with neoplastic disease in particular.

Comparison of B-mode and Doppler ultrasonographic findings with histologic features of benign and malignant mammary tumors in dogs.

OBJECTIVE: To compare and correlate B-mode and color Doppler ultrasonographic characteristics with the histologic findings of benign and malignant mammary tumors in dogs. STUDY POPULATION: 49 mammary tumors in 26 dogs. PROCEDURES: Before excision, tumors were evaluated via B-mode and color Doppler ultrasonography to assess size, echogenicity, echopattern, acoustic transmission, invasiveness, and vascularity. Paraffin-embedded microsections of the tumors were stained with H&E and examined for presence of necrosis, cysts, cartilage, bone, mineralization, invasion of surrounding tissue, and tissue heterogeneity. To assess vascularity, the number and distribution of vessels that were stained by the Verhoeff van Gieson technique were recorded. RESULTS: Tumor echogenicity and echopattern on ultrasonographic images correlated with tissue heterogeneity detected histologically. Acoustic enhancement was correlated with the presence of necrotic or cystic areas. Tumor invasion into surrounding tissues as determined ultrasonographically did not correlate with the histologic findings. There was a significant correlation between the number of detected vessels and distribution of flow within the tumors determined via ultrasonographic and histologic examinations. CONCLUSIONS AND CLINICAL RELEVANCE: In canine mammary tumors, ultrasonographic characteristics appear to be correlated with histopathologic changes. Data suggest that ultrasonography may have an important role in the evaluation of mammary tumors in dogs, particularly in the evaluation of tissue composition and tumor vascularity.

Characterization of canine superficial tumors using gray-scale B mode, color flow mapping, and spectral doppler ultrasonography--a multivariate study.

Superficial tumors are not routinely evaluated by two- or three-dimensional diagnostic imaging methods as part of the staging of canine cancer patients, although superficial tumors are readily imaged by ultrasound. The objectives of this study were to characterize the ultrasonographic patterns of superficial tumors and to evaluate whether ultrasound can help discriminate between benign and malignant tumors in dogs. Superficial tumors (n=132) in 86 dogs were evaluated by B mode, color flow mapping, and spectral Doppler ultrasonography. Size, echogenicity, tumor border definition, invasiveness, acoustic transmission, presence and distribution of vascular flow to and within the tumor, as well as perfusion indices were measured. The tumors were classified as lipomas, benign tumors, atypical mammary tumors, and malignant tumors. Multivariate statistics using discriminant analysis was used to determine which parameters may be used to predict the status of the tumor. Tumor echogenicity, border shape, acoustic shadowing, total number of vessels to the tumor and the total flow amount are the parameters that in combination resulted in the lowest classification error (24%), meaning that on average three out of four tumors were correctly classified using these parameters. All the lipomas and atypical mammary tumors were classified correctly by ultrasonography. The results of this study show that ultrasonography has an important role in the evaluation of canine superficial tumors, particularly in the evaluation of tissue homogeneity and tumor vascularity.

Characterization of normal and abnormal canine superficial lymph nodes using gray-scale B-mode, color flow mapping, power, and spectral Doppler ultrasonography: a multivariate study.

The objective of this study was to characterize the ultrasonographic patterns of normal superficial lymph nodes and to evaluate whether ultrasonography can help discriminate between different lymphadenopathies (reactive, lymphoma, and metastases) in dogs. Three hundred and eighteen superficial lymph nodes in 142 dogs were studied by B-mode, color flow mapping, power, and spectral Doppler ultrasonography. Size, echogenicity, nodal border definition, presence of a nodal hilus, acoustic enhancement and distribution of vascular flow, as well as perfusion indices were measured. Multivariate statistics using discriminant analysis was used to determine which parameters can be used to predict the diagnosis of the lymph node. The size of the lymph node, distribution of vascular flow within the lymph node, and pulsatility index (PI) in combination gave a classification error of 23% for the four groups of lymph nodes. This was improved to 11% if the nodes were divided into two groups: benign and malignant. There was a significant difference in resistive index (RI) and PI between benign and malignant nodes. Cut-off values were determined using receiver operator curves, 0.68 RI and 1.49 PI.

Contrast-enhanced ultrasonography in normal canine liver. Evaluation of imaging and safety parameters.

Contrast-enhanced ultrasonography, a new imaging modality in veterinary medicine, can provide data on tissue perfusion. The objective of this study was to use the ultrasonographic contrast agent SonoVue to evaluate various transit time indices in the normal canine liver, to examine the effect of anesthesia on these parameters, and to evaluate the safety of this agent in dogs. The liver of 11 healthy dogs was studied by ultrasound during an intravenous bolus injection of SonoVue. Each dog underwent the examination twice, first with and later without the use of anesthesia. A time-intensity curve was generated from a selected region of interest within the liver from each scanning session. Ratios derived from peak enhancement, time to peak enhancement, up-slope and full-width half-maximum (FWHM) of the curve were calculated from the time-intensity curves, and are reported. There were no statistically significant differences (P > 0.05) in peak enhancement, up-slope and FWHM between dogs that were anesthetized and dogs that were not. Time to peak enhancement, however, was significantly shorter when the dogs were anesthetized than when they were nonanesthetized (P < 0.05). There were no biologically significant changes in clinical laboratory findings. This study indicates that contrast-enhanced ultrasound using SonoVue gives reproducible liver perfusion data, and appears to be a safe and well-tolerated agent for use in dogs. When considering normal values, the use of anesthetic drugs has to be considered.

A review of the sonographic assessment of tumor metastases in liver and superficial lymph nodes.

Diagnostic imaging techniques are an important part of the diagnostic workup and staging of cancer patients. Ultrasound is of particular interest in this respect. In so far as tumor metastases are concerned, ultrasonography of regional lymph nodes and of the liver can provide valuable information. In humans many criteria, some of them objective, have been evaluated as indicators of malignancy. The most diagnostically helpful of these include the short/long axis ratio of the lymph node, the pattern of distribution of the blood vessels within the lymph node, and to some extent the calculated values for resistive and pulsatility indices. Putative objective criteria to improve the specificity of ultrasound for metastases detection in the liver have also been evaluated. These include perfusion indices, primarily using analysis of Doppler frequencies (Doppler perfusion index) and hepatic venography using an ultrasound contrast agent. Contrast-enhanced ultrasonography is a new and promising area to help the initial diagnosis and characterization of malignancy, particularly for focal lesions in the liver. This review discusses the use of ultrasound for detection of metastases and presents material from four veterinary cases.