Metal detector and swallowed metal foreign bodies in children.
OBJECTIVE: To evaluate a metal detector to diagnose swallowed radio-opaque metal foreign bodies (MFBs) in children, and whether they can detect non-radio-opaque MFBs. METHODS: In a prospective study, 231 children, who presented to the accident and emergency department with a history of swallowing MFBs, were evaluated by the metal detector as well as radiography to confirm and locate the presence or absence of MFBs. RESULTS: A definite history of swallowing a MFB by the child was given by 186 (81%) parents. The metal detector located MFBs in 183 children and radiographs confirmed radio-opaque MFBs in 181. In the remaining 45 (19%), when swallowing was suspected and not definite, both metal detector and radiography confirmed the presence of a MFB in only four. CONCLUSION: A high detection rate of swallowed MFBs was observed in this study, using a metal detector. It is also of value to detect non-radio-opaque MFBs like aluminium. The detection of MFBs is high when the history of swallowing is definite. (+info
Understanding financing options for PACS implementation. Picture archiving and communication systems.
The acquisition of expensive equipment such as picture archiving and communication systems (PACS) becomes increasingly difficult as capital budgets become tighter. Traditional ownership financing options in the form of direct purchase or financing (loan) have several limitations including technology obsolescence, higher fixed pricing, limited options for equipment disposal, and the need to tie up valuable capital. Alternative financing options, in the form of conventional lease and risk sharing arrangements, offer several theoretical advantages including technology obsolescence protection in the form of built-in upgrades, preservation of borrowing power, multiple end-of-term options, and payment flexibility (which can be directly tied to realized productivity and operational efficiency gains). These options are discussed, with emphasis on the acquisition of PACS. (+info
Development of a multifrequency conductance catheter-based system to determine LV function in mice.
Transgenic mice offer a valuable way to relate gene products to phenotype, but the ability to assess the cardiovascular phenotype with pressure-volume analysis has lagged. Conductance measurement offers a method to generate an instantaneous left ventricular (LV) volume signal in the mouse but has been limited by the volume signal being a combination of blood and LV muscle. We hypothesized that by developing a mouse conductance system that operates at several simultaneous frequencies, we could identify and correct for the myocardial contribution to the instantaneous volume signal. This hypothesis is based on the assumption that mouse myocardial conductivity will vary with frequency, whereas mouse blood conductivity will not. Consistent with this hypothesis, we demonstrated that at higher excitation frequency, greater end-diastolic and end-systolic conductance are detected, as well as a smaller difference between the two. We then empirically solved for LV blood volume using two frequencies. We combined measured resistivity of mouse myocardium with an analytic approach and extracted an estimate of LV blood volume from the raw conductance signal. Development of a multifrequency catheter-based system to determine LV function could be a tool to assess cardiovascular phenotype in transgenic mice. (+info
Changing patterns of sedation use for routine out-patient diagnostic gastroscopy between 1989 and 1998.
BACKGROUND: Knowledge of sedation trends for upper gastrointestinal endoscopy is important for health service planning, particularly in view of rapidly increasing demands on endoscopy services. However, no data are available on sedation trends in Britain over the past 10 years. AIM: To determine sedation use for routine gastroscopy in a single endoscopy unit between 1989 and 1998. METHODS: This was a retrospective study of 9795 consecutive adults (mean age 56 years, range 18-100 years; 4512 females) who had undergone a gastroscopy between 1989 and 1998. Clinical, pharmacological and endoscopic data were retrieved from a computerized database. RESULTS: Over the 10-year study period, the sedation rate remained constant for patients undergoing therapeutic endoscopy (P=0.99) and those undergoing in-patient diagnostic examinations (P=0.63). In contrast, the sedation rate for out-patient diagnostic endoscopy decreased by 54%, from a high of 70% in 1990 to 32% in 1998 (P < 0.0001). Logistic regression analysis showed that the decline in sedation use was greater in females (P < 0.0001) than males and in procedures performed by non-consultant compared to consultant staff (P=0.01). CONCLUSIONS: If our results form part of a national trend, they will have important implications for cardiopulmonary monitoring strategies, recovery room practices and for complication rates due to the use of sedation for upper gastrointestinal endoscopy. (+info
A comparison between two methods of aesthesiometric assessment in patients with hand-arm vibration syndrome.
Hand-arm vibration syndrome (HAVS) is caused by prolonged exposure to vibration. The diagnosis and assessment of disease severity are subjective at present. The aim of this study was to determine sensorineural dysfunction in patients with HAVS using two methods of aesthesiometric assessment. We recruited three groups of age-matched subjects: 20 subjects diagnosed as having HAVS, 15 manual workers and 15 sedentary workers. We measured both two-point discrimination and depth sense perception using an aesthesiometer. We found that the two-point discrimination wheel was more accurate than the depth sense perception wheel at detecting levels of sensorineural dysfunction in subjects with HAVS. The increased sensitivity of the two-point disc would suggest that it should be used in preference to the depth sense disc for the assessment of sensorineural dysfunction in patients with HAVS. (+info
A comparison of transcutaneous bilirubinometers: SpectRx BiliCheck versus Minolta AirShields.
BACKGROUND: Two devices are available for making transcutaneous estimates of serum bilirubin (SBR): the Minolta AirShields JM102 and the new SpectRx BiliCheck. OBJECTIVES: (a) To measure how well the readings produced by these devices agree with SBR measured in the laboratory; (b) to estimate for each device, the proportion of infants with clinical jaundice who would require blood sampling if the device was used as a screening tool to detect infants with SBR > or = 250 micromol/l. DESIGN: Prospective cohort study of jaundiced infants who required SBR at < or = 20 days of postnatal age. Those who had received phototherapy or exchange transfusion were excluded. SETTING: Tertiary neonatal service in South-East Scotland. INTERVENTIONS: Within 30 minutes of SBR sampling, transcutaneous bilirubinometry was performed using one Minolta and two SpectRx devices (designated A and B). RESULTS: Sixty-four neonates were enrolled, 19 of which were preterm (31-35 weeks). The 95% confidence intervals of a device reading corresponding to SBR were +/- 66.7, +/- 67.9, and +/- 66.4 micromol/l respectively. Using the devices to identify all SBR > or = 250 micromol/l would reduce SBR sampling by 23%, 16%, and 20% respectively. CONCLUSIONS: Given that SBR levels range from 50 to 400 micromol/l in jaundiced infants, the 95% confidence intervals of the devices are wide at +/- 67 micromol/l. The SpectRx can be used as a screening tool for hyperbilirubinaemia but there is no advantage in using it over the Minolta. (+info
Medical devices; obstetrical and gynecological devices; classification of the breast lesion documentation system. Final rule.
The Food and Drug Administration (FDA) is classifying the breast lesion documentation system into class II (special controls). The special controls that will apply to this device are discussed later in this document. The agency is taking this action in response to a petition submitted under the Federal Food, Drug, and Cosmetic Act (the act) as amended by the Medical Device Amendments of 1976 (the amendments), the Safe Medical Devices Act of 1990, and the Food and Drug Administration Modernization Act of 1997 (FDAMA). The agency is classifying this device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. Elsewhere in this issue of the Federal Register, FDA is publishing a notice of availability of a guidance document that is the special control for this device. (+info
Medical devices: classification of the dental sonography device and jaw tracking device. Final rule.
The Food and Drug Administration (FDA) is classifying the dental sonography device into class I, when it is used to monitor temporomandibular joint sounds, and into class II, when it is used to interpret temporomandibular joint sounds for the diagnosis of temporomandibular joint disorders and associated orofacial pain. FDA is classifying the jaw tracking device into class I, when it is used to monitor mandibular jaw positions relative to the maxilla, and into class II, when it is used to interpret mandibular jaw positions relative to the maxilla, for the diagnosis of temporomandibular joint disorders and associated orofacial pain. Elsewhere in this issue of the Federal Register, FDA is announcing the availability of a guidance document that will serve as the special control for this device. FDA is taking this action under the Federal Food, Drug, and Cosmetic Act (the act) as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), the Food and Drug Administration Modernization Act of 1997 (FDAMA) and the Medical Device User Fee and Modernization Act of 2002 (MDUFMA). (+info