Peri-radiographic guidelines for children with autism spectrum disorder: a nationwide survey in Sweden.

OBJECTIVE: This study aimed to investigate the prevalence of guidelines and routines used nationwide when children with autism spectrum disorder (ASD) are taken care of and examined in a radiology department during a peri-radiographic process. METHOD: A nationwide survey was compiled and distributed to 94 radiology departments throughout Sweden, i.e. those performing more than 100 000 radiographic examinations annually. The survey was designed as a web questionnaire with seven questions on possible guidelines and/or routines for the departments when preparing and taking care of children with ASD in conjunction with a radiographic procedure. The data were scrutinized, using descriptive statistics. RESULTS: In total, 86 radiology departments responded to the survey (response rate 92%). Of those departments, 40 did not examine children with ASD. None of the departments included in the study had existing guidelines underpinning the routines when preparing and performing radiographic examinations for children diagnosed with ASD. A few departments (n = 8) would set aside more time for the procedure if it were known in advance that the child to be examined had been diagnosed with ASD. Also, some departments (n = 7) had radiographers who were more experienced in the care of children who would be appointed to perform examinations for children with ASD. CONCLUSION: It is suggested that guidelines should be developed in order to increase interaction in a supportive way and decrease anxiety during the peri-radiographic process with children with ASD.

Nurses' experiences of caring for children in pain.

AIM: To describe nurses' experiences when caring for children in pain. BACKGROUND: Earlier studies have shown that nurses are key actors in pain management and that there is a need to focus on the nurses' own experiences of caring for children in pain. METHOD: Semi-structured interviews were conducted with 21 nurses at one paediatric clinic. The data were analysed by means of content analysis. RESULTS: The interviews suggested that when a child's pain followed an expected pattern and they complied with treatment, the nurses trusted their knowledge and felt comfortable. On the other hand, in unpredictable situations the nurses felt fearful, powerless, abandoned and distrustful. CONCLUSION: The nurses were comfortable in predictable situations, but if a situation was unpredictable, they felt they had lost control over it. IMPLICATIONS FOR PAIN MANAGEMENT: To reduce feelings of abandonment, work shifts should be organized so that more experienced nurses can work side by side with those who are less experienced. Pain assessment tools and guidelines for pain management should be introduced into the daily work, and systematic reflection should be used for nurses' professional development.

Reliability and validity of the Swedish version of the modified Yale Preoperative Anxiety Scale.

BACKGROUND: The modified Yale Preoperative Anxiety Scale (m-YPAS) is an observational behavioral checklist that has been widely used as an indicator of pre-operative anxiety in children. The present study describes the translation process of m-YPAS into Swedish and the testing of its reliability and validity when used with Swedish children. METHODS: The questionnaire was translated using standard forward-back-forward translation technique. The validation process was divided into two phases: a pilot study with 61 children as a first version and a test of a final version with 102 children. RESULTS: The reliability tested with Cronbach's alpha was acceptable to good. Interrater reliability analyzed with weighted kappa was acceptable to good with Students Registered Nurse Anesthetists and Certified Registered Nurse Anesthetist (CRNA) as evaluators (phase 1) and good to excellent with CRNA's very experienced in child anesthesia (phase 2). Both concurrent and constructed validity could be demonstrated. CONCLUSION: This validation study of the Swedish version of the m-YPAS shows good consistency, interrater validity, and construct validity when used by experienced assessors.

Thermal growth performance of juvenile brown trout Salmo trutta: no support for thermal adaptation hypotheses.

Using thermal growth data from eight populations of anadromous and lake-feeding brown trout Salmo trutta, hypotheses of adaptation to local optima and countergradient variation in growth were tested. The adaptation to local optima hypothesis suggests that natural selection can shift optimal performance temperatures to match the prevailing temperature in a new or changed thermal niche. In contradiction, the countergradient variation hypothesis suggests that populations from hostile environments perform better than conspecifics from benign environments at all temperatures. In this study, growth capacity varied between populations but there was no significant correlation between any of the estimated thermal performance parameters (e.g. lower and upper thermal growth limits, optimal temperature for growth and maximum growth capacity) and natural climatic conditions among populations. Hence, S. trutta growth response to temperature lends no support for either of the two suggested thermal adaptation hypotheses. Instead, growth capacity among populations tended to correlate positively with female size at maturity.

Quarter milking for improved detection of increased SCC.

The aim of the present study was to investigate whether milk composition and milk yield are changed in relation to a moderate increase in milk somatic cell count (SCC) in separate udder quarters. During a period of 13 weeks, 4158 bulk quarter milk samples from 68 cows were collected and analysed for milk SCC and milk composition. The sampling was done twice weekly. The cows were in different stages of lactation and in different lactation numbers. For calculations, three groups of cows were formed according to their SCC value. Group 1 cows, where all quarters had an SCC <100,000 cells/ml at all sampling occasions, were considered to be non-affected. Group 2 cows had one udder quarter with an increased SCC >100,000 cells/ml and 1.5-fold higher than the opposite quarter at one sampling occasion. For group 3 cows, the increase in SCC remained for several consecutive sampling occasions. Data from group 1 cows revealed that front and rear quarters were similar when compared with each other. For group 3 cows, the lactose content in milk decreased significantly, simultaneously with the increase in SCC and remained decreased for two sampling occasions after the initial increase in SCC. It was concluded that deviations in lactose content within front and rear quarters, respectively, may be a useful tool for detection of moderately increased SCC in separate udder quarters.

Determinants of cancer patients' utilization of hospital care within two years after diagnosis.

This study aimed to identify factors at diagnosis that are related to cancer patients' utilization of hospital care during the first 2 years after diagnosis, and thereby improve identification of patients with an increased need for close follow-up. Data from a prospective intervention study of psychosocial support and from a computerized patient administration system were used. A total of 393 newly diagnosed patients were included. Hierarchical regression analyses were performed to determine whether the addition of information regarding age, comorbidity, functional status, symptoms, and socioeconomic variables improved the prediction of utilization of specialist inpatient care beyond that afforded by cancer-related factors. In addition to cancer diagnosis and treatment, comorbidity, physical function, and pain determined use of inpatient care. Patients living in rural areas and those with a low income utilized hospital care more often. The results suggest that thorough assessment can identify patients at diagnosis with an increased need for follow-up, e.g. intensified home care services.

Optimization of ECG gating in quantitative femoral angiography.

PURPOSE: To determine which phase of the heart cycle would yield the highest reproducibility in measuring atherosclerosis-related variables such as arterial lumen volume and edge roughness. MATERIAL AND METHODS: 35 patients with hypercholesterolemia underwent select- ive femoral angiography, repeated four times at 10-min intervals. The angiographies were performed with ECG-gated exposures. In angiographies 1 and 2 the delay from R-wave maximum to each exposure was 0.1 s, in angiographies 3 and 4 the delay was 0.1, 0.3, 0.5 or 0.7 s or the exposures were performed 1/s without ECG gating. Arterial lumen volume and edge roughness were measured in a 20-cm segment of the superficial femoral artery using a computer-based densitometric method. Measurement reproducibility was determined by comparing angiographies 1-2 and angiographies 3-4. RESULTS: When measuring arterial lumen volume and edge roughness of a 20-cm segment of the femoral artery, reproducibility was not dependent on ECG gating. In measuring single arterial diameters and cross-sectional areas, the reproducibility was better when exposures were made 0.1 s after the R-wave maximum than when using other settings of the ECG gating device or without ECG gating. CONCLUSION: The influence of pulsatile flow upon quantitative measurement in femoral angiograms seems to be the smallest possible in early systole, as can be demonstrated when measuring single diameters and cross-sectional areas. In variables based on integration over longer segments, measurement reproducibility seems to be independent of phase.

Effects of gonadectomy and androgen treatments on pituitary and plasma levels of gonadotropins in mature male Atlantic salmon, Salmo salar, parr--positive feedback control of both gonadotropins.

The aim of the present study was to clarify the role of feedback control on the (brain)-pituitary-gonadal axis in regulating FSH (gonadotropic hormone, GTH I) and LH (GTH II) in natural maturation in salmonids. In two experiments, 2-yr-old previously mature Atlantic salmon male parr were castrated or sham operated in the spring following their first reproductive season. In one of the experiments, castrated fish were also implanted with silicone elastomer capsules containing testosterone (T) or 11-ketoandrostenedione (11KA). The fish were sampled in July, September, and November (spawning period). Pituitary and plasma LH and FSH levels were measured using RIA and were lower in castrated than in sham-operated fish, indicating positive feedback on both FSH and LH. T, and to a lesser extent 11KA, increased pituitary LH content in castrated fish. The 11KA increased plasma and pituitary FSH levels, whereas T suppressed FSH in July and stimulated it in November. Plasma FSH levels peak earlier than LH, and it is suggested that if one or more feedback effects are involved in controlling the "all-or-nothing response," i.e., whether a fish will mature or not, a feedback effect on FSH is the most likely candidate.

What is important in psychiatric outpatient care? Quality of care from the patient's perspective.

The development of quality assurance programmes for psychiatric care has increased the interest in quality of care and accountability from the patient's perspective. The aims of this study were threefold. First, to map descriptive characteristics of ideal outpatient psychiatric care through open-ended patient interviews, using a sample of 94 psychiatric outpatients, second, to have another sample of 84 outpatients rank the importance of 57 treatment characteristics extracted from the qualitative analysis of the interviews, and third to make comparisons with a previously performed investigation on quality of care of psychiatric inpatients. Results of the content analysis showed that characteristics of ideal outpatient treatment could be classified in eight content categories: accessibility of care, treatment content, staff-patient relationship, continuity of care, staff's professionalism, patient information/co-influence, treatment environment and cost of care. Results from the patients' rating of the importance of treatment characteristics showed that patients put the highest emphasis on staff's empathetic qualities in being interested, understanding, listening and respecting patients. Comparisons with the previously studied inpatient sample, showed great similarities in what was considered important to reach a satisfactory care situation. It is concluded that in order to secure content validity of investigations of the quality of psychiatric care from the patient's perspective, effort should be put into including the areas of staff-patient relationship and patient information and co-influence.

Effects of aromatase inhibitors on sexual maturation in Atlantic salmon, Salmo salar, male parr.

Atlantic salmon, Salmo salar, male parr were implanted with Silastic capsules filled with different aromatase inhibitors: 1,4,6-androstatriene-3,17-dione (ATD), 4-hydroxy-4-androstene-3,17-dione (4OH), and the non-steroidal CGS16949 A, 4-benzonitrile monohydrochloride (CGS). Aromatization in brain homogenates were lower in salmon implanted with CGS and ATD than in controls. This was not the case for 4OH, but administration of 4OH to brain homogenates reduced the aromatase activity. All three aromatase inhibitors had effected gonadal weights in fish sampled in the summer, but the effects were markedly different among inhibitors. Plasma levels of the androgen 11-ketotestosterone (11KT) and the progestin 17α, 20ß-dihydroxy-4-pregnen-3-one (17,20P) were measured by means of radioimmunoassay. CGS and ATD, but not 4OH, significantly decreased the plasma 17,20P levels in the autumn. Plasma levels of 11 KT were not influenced by ATD or CGS treatment, but 4OH had a lowering effect in one autumn sampling. ATD and 4OH (CGS not tested) increased the proportion of maturing males.These findings suggest that aromatization is of physiological importance in different mechanisms controlling reproduction in salmon.

What is important in psychiatric inpatient care? Quality of care from the patient's perspective.

The development of quality assurance programs for psychiatric care has increased the interest in quality of care and accountability from the patient's perspective. However, most investigations of patient satisfaction use instruments which rate aspects of care defined and held to be important by professionals and care givers. The aims of this study were 2-fold. To map descriptive characteristics of ideal inpatient psychiatric care through open patient interviews, using a sample of 78 hospitalized patients and, secondly, based on a content analysis of these interviews, to have another sample of 77 hospitalized patients rank the importance of 48 treatment characteristics extracted from the qualitative analysis. Results of the content analysis showed that characteristics of ideal inpatient treatment could be classified in six categories: staff-patient relationship, patient co-influence, treatment content, activities, ward atmosphere and staff competence. Results from the patients' rating of the importance of treatment characteristics showed that patients put the highest emphasis on staff empathic qualities: being caring, interested and understanding, respecting patients, devoting time to patients, and creating a safe treatment environment. The least importance was ascribed to characteristics of the physical environment and daily routines on the ward. It is concluded that in order to secure content validity of investigations of the quality of psychiatric inpatient care from the patient's perspective, effort should be put into including the areas of staff-patient relationships and patient information and co-influence.

Image operations in quantification of atherosclerosis from digitized angiograms.

This report describes a method of quantifying the inner volume (lumen volume) of a contrast medium-filled femoral artery from a roentgenogram by computerized image analysis. The various factors influencing the accuracy of the volume determination are analyzed and an image-processing procedure for the elimination of artifacts due to crossing arteries is described and evaluated. The presented methods have been used in a large study of 281 patients and the short-term reproducibility has been found to be 1.00.

Effects of castration and androgen treatment on aromatase activity in the brain of mature male Atlantic salmon (Salmo salar L.) parr.

Brain homogenates from male Atlantic salmon parr aromatized tritiated androstenedione to estrogens. The aromatase activity in homogenates of whole brains from castrated male parr was lower than that in homogenates from sham-operated male parr in autumn. This was also found in homogenates of the telencephalon and diencephalon, but not in homogenates of the tectum opticum. Treatment of castrated males with testosterone (T) and 11-ketoandrostenedione (OA) increased the aromatase activity in whole brains. T, but not OA, also significantly increased aromatase activity in all brain parts. In spring, half a year after the peak breeding period, mature parr males had a lower aromatase activity in telencephalon, diencephalon and tectum than that found in castrated males in autumn, whereas immature males displayed an even lower level of activity.

Atherosclerosis-related measures in digitized femoral arteriograms.

Atherosclerosis is reflected in the arteriogram as narrowing of the arterial lumen and irregularity of the arterial wall. We have quantified these changes in digitized femoral arteriograms from 107 hypercholesterolaemic patients and defined 10 different measures concerning arterial diameter, cross-sectional area, stenosis and edge irregularity. We examined the precision of these measures and the correlations between them. Lumen volume and mean diameter for defined arterial segments had the highest precision and may be useful for follow-up studies. The linear correlation between the mean diameter and the square root of the lumen volume was greater than 0.99, so these two measures seem to be equivalent for all practical purposes. The measured variables could be separated into 2 groups: the measures concerning arterial diameter and lumen volume and those concerning edge irregularity and localized stenosis. The measures within each group showed strong positive mutual correlations, while the correlations between measures from different groups were negative and small. It was concluded that if the results of one measure from each group, suitably those of lumen volume and edge roughness, are known, the other described measures will add no further information about the atherosclerotic process.

Arterial segmental vasoconstriction in hypercholesterolaemic patients.

Regular, wave-like constriction in medium-sized arteries, arterial segmental vasoconstriction (ASV), has been observed at arteriography and described by many authors. We found ASV in arteriograms of the superficial femoral artery in 13 of 107 hypercholesterolaemic patients, enrolled in the Probucol Quantitative Regression Swedish Trial (PQRST). The arteriograms were digitized and studied with a quantitative computer-assisted technique. The frequency of ASV was higher than has been reported earlier in clinical materials, possibly because of an increased vasoreactivity in hypercholesterolaemia, as recently observed experimentally. The ASV patients were, on average, younger, had lower blood pressure and less atherosclerosis, than the non-ASV patients. ASV was not found in any of the 19 patients in the material who either had symptoms of peripheral vascular disease or arteriographically verified arterial occlusions. No significant correlations with smoking habits or serum cholesterol levels were found. A computer-based index of ASV and measurement of ASV wavelength are discussed.

Quantitation of atherosclerosis in femoral arteriography with ECG gated exposures.

Using a densitometric method introduced in 1977 by Crawford et coll. the volumes of segments of the femoral artery were calculated from two angiographic series in each of 13 patients. ECG gated exposures were used to minimise the error of the method. The reproducibility of the method was found to be better than in a previous study in which ECG gating was not used. The method may therefore be of use in long term angiographic follow-up studies of atherosclerotic lesions, although the impact of different investigation parameters on methodologic precision is still not fully known.