The following recommendations are intended to offer a practical approach to the understanding of non-technical issues arising in a vascular laboratory. While as sonographers we would all probably prefer to focus on the technical aspect of the profession, we are also living in a society shaped with policies, rules and regulations. It is therefore imperative that we also understand the non-technical aspects of the profession, to maneuver safely in clinical setting and offer safety and quality to our patients.
Introduction: Community-based cardiovascular screening presents an opportunity to detect the presence of cardiovascular disease in individuals who report having no traditional risk factors, and also to identify the presence of those risk factors in those who are unaware of their health status. Identification of both disease and risk factors (e.g. high cholesterol, high blood pressure, diabetes, etc.) creates an opportunity for treatment and management to reduce and prevent cardiovascular events from occurring. Methods: Over 230,000 screening records for individuals who had undergone carotid artery stenosis (CAD), abdominal aortic aneurysm (AAA), or peripheral artery disease (PAD) screening were reviewed. Participants were stratified based on self-reported risk factors as having no risk factors, one risk factor, or two or more risk factors. Self-reported risk factors were also compared with results of screening for blood pressure, blood glucose, and lipid level status. Results: Abnormal findings of CAS, AAA, and PAD were all uncovered in individuals who self-reported as having no traditional risk factors. These abnormal findings included those defined as severe. The review of self-reported risk factors for accuracy demonstrated varying levels of inaccuracies in both under and over-reporting of risk factors. Conclusions: Communitybased cardiovascular screening may result in the identification of cardiovascular disease in individuals with no established risk factors. While the underreporting of risk factors has also be demonstrated, it is clear that further research is warranted to better understand the presence of disease in the absence of risk factors.
In 2008, approximately 11,000 women in the United States will be diagnosed with cervical cancer and more than 3,800 American women will die of this disease. The recent approval by the Food and Drug Administration of a human papillomavirus (HPV) vaccine that is over 90% effective in preventing new infections and precancerous cervical lesions caused by the HPV types that cause cervical cancer may possibly reduce the incidence of cervical cancer. However, a number of unresolved issues exist regarding this vaccine. This paper will explore considerations and challenges facing healthcare educators regarding the HPV vaccine in the following areas: (a) demographic, (b) social, (c) economic, (d) ethical, and (e) political.
In Case 1, A 65-year-old man with a family history of carotid body paraganglioma and no other risk factors was referred to the noninvasive vascular laboratory for a carotid duplex with complaints of left eye amaurosis fugax. In Case 2, an 84-year-old woman with a history of hypertension and hyperlipidemia presented to the noninvasive vascular laboratory for carotid duplex under the suspicion of a right hemisphere transient ischemic attack. Duplex sonography of both cases recorded minimal <49% stenosis of both internal carotids. However, in Case 1, a homogenous mass was noted at the left carotid bifurcation, apparently fed by a branch of the external carotid artery, that later was confirmed by angiography to be a branch of the pharyngeal artery.
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