An introduction to contextual family nursing therapy

The author has extensive experience interacting with families in clinical settings, clinical competency, multidisciplinary collaboration experience, and experience exploring the development of the nursing role. I used four research steps to integrate several decades of research experience and findings in order to propose a theoretical framework and practical therapeutic competency. I hope this introduction offers insights to hardworking nurses and helps them address the many possible family situations that could arise in clinical settings.     

Impact of a Computer-Aided Detection (CAD) System Integrated into a Picture Archiving and Communication System (PACS) on Reader Sensitivity and Efficiency for the Detection of Lung Nodules in Thoracic CT Exams

The objective of this study is to assess the impact on nodule detection and efficiency using a computer-aided detection (CAD) device seamlessly integrated into a commercially available picture archiving and communication system (PACS). Forty-eight consecutive low-dose thoracic computed tomography studies were retrospectively included from an ongoing multi-institutional screening study. CAD results were sent to PACS as a separate image series for each study. Five fellowship-trained thoracic radiologists interpreted each case first on contiguous 5 mm sections, then evaluated the CAD output series (with CAD marks on corresponding axial sections). The standard of reference was based on three-reader agreement with expert adjudication. The time to interpret CAD marking was automatically recorded. A total of 134 true-positive nodules, measuring 3 mm and larger were included in our study; with 85 ≥ 4 and 50 ≥ 5 mm in size. Readers detection improved significantly in each size category when using CAD, respectively, from 44 to 57 % for ≥3 mm, 48 to 61 % for ≥4 mm, and 44 to 60 % for ≥5 mm. CAD stand-alone sensitivity was 65, 68, and 66 % for nodules ≥3, ≥4, and ≥5 mm, respectively, with CAD significantly increasing the false positives for two readers only. The average time to interpret and annotate a CAD mark was 15.1 s, after localizing it in the original image series. The integration of CAD into PACS increases reader sensitivity with minimal impact on interpretation time and supports such implementation into daily clinical practice.     

COMT haplotype analyses in Malaysians with schizophrenia

The present study included a total 261 patients with schizophrenia and 261 healthy controls to replicate the genetic association between the cathechol-o-methyltransferase gene and schizophrenia using a haplotype block-based gene-tagging. The G-G-G haplotype was found to show a highly significant association with schizophrenia.     

Jejunum is more important than terminal ileum for taurocholate absorption in rats

The terminal ileum, with its active transport system, is considered the major site of bile salt absorption. However, earlier studies used bile salt concentrations below physiological levels and may not apply in vivo. Analysis of these studies shows that ileal active transport cannot account for total bile salt recovery. To reevaluate bile salt absorption in rats, we used four preparations and physiological bile salt concentrations. Studies with intestinal sacs showed that, above critical micellar concentration, uptake of taurocholate (TC) was equal in both jejunum and ileum and linear with respect to concentration. A similar pattern was observed in studies of mucosal-to-serosal TC transport using a flux chamber. In vivo studies in anesthetized rats showed approximately 30% of TC absorbed from proximal jejunum and appearing in bile when the bolus had traversed only half the intestine. In unanesthetized fed rats, 60% of TC appeared in bile before the bolus reached distal ileum. Because luminal concentrations of TC are highest proximally, passive absorption by the proximal intestine is mainly responsible for conserving TC within the enterohepatic circulation. Ileal active transport is more efficient at low concentrations and absorbs the TC remaining after proximal absorption.     

Using age‐referenced prostate‐specific antigen percentile to predict survival outcomes in screened Taiwanese men

The survival outcomes of Asian men with elevated prostate‐specific antigen (PSA) levels at screening are largely unknown. We present the clinical outcomes of Taiwanese men based on their screening PSA levels. Between 1994 and 2006, 27,761 men aged over 40 years underwent PSA screening in a self‐funded health examination. The clinical database was linked with the national cancer and death registry databases to generate prostate cancer incidence, prostate cancer mortality (PCM) and overall mortality (OM). Participants were followed until the end of 2009. Survival analyses were performed for the participants' outcomes, and were stratified by five 10‐year age strata (age 40–<50, 50–<60, 60–<70, 70–<80 and ≥80), and six age‐referenced PSA percentile groups, divided by the 50th, 75th, 90th, 95th and 99th percentile of PSA values for each 10‐year age stratum. The median age of the 27,761 men was 54.7 years. The median PSA level at cancer diagnosis was 4.46 ngml^?1. Specifically, the PSA levels for the five 10‐year age strata in order of respectively increasing ages were 1.93, 3.50, 4.10, 6.94 and 12.4 ngml^?1. After a median follow‐up of 8.4 years, 2,463 men died and 337 were diagnosed with prostate cancer. Among the 337 patients, 29 (8.6%) died of prostate cancer. The prostate cancer incidence, PCM and OM rates were higher in men with higher age‐referenced PSA percentile values. The 10‐year PCM rate for men with ≥ the 99th age‐referenced PSA percentile was 3.9%, which was significantly higher than the rate of ≤ 0.5% in the lower percentile groups.     

Three-Dimensional Elastography for Cervical Lymph Node Volume Measurements: A Study to Investigate Feasibility,Accuracy and Reliability

This study investigated the feasibility of using three-dimensional (3-D) elastography in measuring cervical lymph node volume and compared the accuracy and reliability of 3-D elastography and 3-D grayscale ultrasound in measurement of ill-defined cervical nodes. Eighteen porcine lymph nodes from the neck were embedded in tissue-mimicking phantoms and scanned with the two ultrasound techniques. Ultrasound measurements were compared with the volume determined by water-displacement method to evaluate measurement accuracy. Inter-observer reproducibility and intra-observer repeatability of measurements were evaluated. Four patients with enlarged neck nodes were included to evaluate intra-observer repeatability of ultrasound measurements. Results demonstrated that lymph nodes that appeared ill-defined on grayscale ultrasound showed well-defined boundaries on elastography. 3-D elastography has higher measurement accuracy (84.2%), reproducibility (intraclass correlation coefficient, ICC = 0.909) and repeatability (ICC = 0.964–0.988) than does 3-D grayscale ultrasound (62.2%, 0.777 and 0.863–0.906 respectively). As a conclusion, 3-D elastography is accurate and reliable in volume measurement of ill-defined lymph nodes and has potential for accurate assessment of lymph node volume.