Continuous positive airway pressure: patients' and caregivers' learning needs and barriers to use.

OBJECTIVE: To identify learning needs and factors related to postdischarge use of continuous positive airway pressure (CPAP) ventilation. DESIGN: Exploratory descriptive correlational. SETTING: Metropolitan and rural clinics. SUBJECTS: Adult patients (N = 21) and family caregivers, one half 60 years or older. INSTRUMENTS: Family interviews, life satisfaction and quality, family function and relationship, depression and learning preparedness. RESULTS: There were numerous learning needs related to CPAP machine management, monitoring illness severity, and recognizing depressive symptomology, oxygen deficits, and cardiovascular sequelae. Family members are involved in overcoming barriers interfering with nightly CPAP use. Interview and questionnaire data clearly indicate life satisfaction improves after CPAP treatment. CONCLUSION: Predischarge and teaching programs coordinated by expert nurses are needed to address families' learning needs and support habitual long-term CPAP use. Family problem solving and depression interventions, instruction on recognizing symptoms of cardiovascular complications, and long-term follow-up programs are currently being studied.

High-resolution computer display of portable, digital, chest radiographs of adults: suitability for primary interpretation.

OBJECTIVE: The suitability of using a high-resolution computer-display system for primary interpretation of adult chest radiographs obtained with portable apparatus and storage phosphor technology was evaluated with receiver operating characteristic analysis and subjective methods. MATERIALS AND METHODS: Sixty portable digital chest radiographs showing abnormalities that approached the resolution limits of our computed radiography system were selected. The original digital data making up the 2140 x 1760 x 10 bit images were transferred to a cathode ray tube (CRT) display system composed of two Megascan monitors. Postprocessing rendered two images, one for each monitor, to emulate the two-on-one hard-copy format produced by the computed radiography system. Each image set was interpreted independently by three radiologists experienced with hard-copy format. Limited level and window adjustments were allowed during CRT interpretation. For both CRT and hard-copy display, images were graded on the basis of the interpreter's confidence in the presence of pneumothorax and parenchymal abnormalities. Three types of foreign devices were subjectively analyzed: endotracheal tubes, nasogastric tubes, and temporary epicardial pacer wires. RESULTS: No significant differences were found in detecting pneumothorax or focal infiltrates. One radiologist found the hard copy better for detecting diffuse infiltrates (p = .02); two radiologists favored CRT for visualizing nasogastric tubes (p < .005, p < .02); and one radiologist favored CRT for visualizing temporary epicardial pacer wires (p = .05). CONCLUSION: We conclude that an optimized high-resolution CRT system is quite promising for primary interpretation of digital portable chest radiographs, but further investigation and greater statistical power are necessary to confirm our results.

Teleradiology via narrow-band integrated services digital network (N-ISDN) and Joint Photographic Experts Group (JPEG) image compression.

The importance of remote access to both radiological images and medical information has stimulated many demonstration projects that use a variety of telecommunications providers' offerings. Teleradiology, through modest cost channels, can achieve adequate response times using a combination of narrow-band integrated services digital network (N-ISDN) and data compression. A demonstration project, developed in collaboration with Southwestern Bell Technology Resources, Inc, uses the aggregate bandwidth of two B channels (achieving a rate of 120 kilobits per second) and a block-oriented discrete cosine transform compression/decompression implementation based on the Joint Photographic Experts Group Standard for Still Image Compression. System response measurements for an Inquiry and Display Station accessing the Mallinckrodt Institute of Radiology's Radiology Image and Information Management Testbed via the N-ISDN connection show response times to be within 20 seconds. Viewing applications have been shown at sites within St Louis and at Radiological Society of North America, 1990, in Chicago.