Ultrasound as a complement to mammography and breast examination to characterize breast masses

This study was designed to determine if complementary ultrasound (US) imaging and Doppler could decrease the number of biopsies for benign masses. A total of 761 breast masses were sequentially scored on a level of suspicion (LOS) of 1-5, where 1 represented low, and 5 was a high suspicion of malignancy, for mammography, US, and color flow with pulse Doppler (DUS). After biopsy, the results were analyzed using 2 x 2 contingency tables and ROC analysis, for mammography alone and in combination with US and DUS. The addition of US increased the specificity from 51.4% to 66.4% at a prevalence of 31.3% malignancy. ROC analysis showed that the addition of US significantly improved the performance over mammography alone in women < 55 years old (p = 0.049); > 55 years old (p = 0.029); masses < 1 cm (p = 0.016) and masses > 1 cm (p = 0.016). These results show that the addition of US to mammography alone could substantially reduce the number of breast biopsies for benign disease.     

Evaluation of a simple device for regulating intravenous infusions

Dial-A-Flo, and infusion control device, is assessed for accuracy, in vitro and in vivo. The unit did not permit accurate control and particularly so at lower flow rates. The normal spontaneous variations in venous pressure that occur around an infusions cannula tip, further increase the error of gravity-fed infusions. Dial-A-Flo has no advantage over a standard administration set alone, and should not be used for controlled administration of cardiac drugs.     

Evaluation of a new cervical immobilization/extrication device

A new cervical immobilization device (the Philadelphia Red E.M. Collar with Head Immobilizer/Stabilizer), has been introduced as an adjunct in extricating potentially neck-injured patients. This study compared the efficacy of immobilization using the collar to that of a short spine board. In addition, experienced EMS personnel rated the collar in simulated field situations. METHODS: In Part I of the study, the collar and a short spine board were applied to 25 adult volunteers in a sitting position, using standard methods. Each subject then exerted maximal force in flexion, extension, rotation, and abduction. Degrees of head motion from neutral position were measured in each direction. Mean values were compared using Student's t-test. For Part II, 10 EMS personnel were asked to apply the collar to volunteers. Each rated the performance of the collar on a scale of 1 (poor) to 4 (excellent) regarding: ease of application (sitting and supine), ease of extrication (lifting, logrolling, transfer), access to patient (chest auscultation, CPR, airway management), storage, and overall utility. RESULTS: The collar was significantly better than the short spine board in both lateral and rotational immobilization (p less than 0.001). There was no significant difference for flexion or extension (p greater than 0.05). The Red E.M. limited motion to a mean of 15 degrees or less in any direction. Ratings by EMS personnel for the device (mean+/- standard error) were: ease of application (sitting) 3.5+/-0.2, (supine) 2.7+/-0.2; ease of extrication 3.1+/-0.2; access to patient 3.4+/-0.2; storage 3.1+/-0.3; and overall utility 3.1+/-0.2.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nurse practitioner training in breast examination

BACKGROUND: To date, there have been no published guidelines, either locally or nationally, to advise nurse practitioners on training and assessment in breast and axillary examination. This study is a prospective audit of the clinical competence of a nurse practitioner in breast and axillary clinical examination, following an 18-month period of clinical training and supervision by two consultant breast surgeons. CONCLUSION: The results of the audit show that the nurse achieved a high level of concordance with the findings of consultant breast surgeons. This training and audit process could be incorporated into the training and assessment of future nurse practitioners in this specialist area.     

Evaluation of SURECATH access device

Since the development of the implanted port in the early 1980s, nurses have become very comfortable with the use of non-coring needles to access these devices. The SURECATH port-accessing device replaces the non-coring needle with a flexible Teflon catheter. An initial assessment of 10 patients accessed with the SURECATH device indicated a greater degree of patient comfort while accessed as compared with the non-coring needle. In addition, nursing staff reported increased ease in accessing the implanted port with the SURECATH device. The SURECATH port-accessing device gives nurses an attractive alternative to the non-coring needle when accessing implanted ports.     

Evaluation of platelets collected by a new portable apheresis device

We studied the efficiency of platelet collection by the Mobile Collection System (MCS) using two types of experimental protocols and evaluated the effect of storage at 22°C on the platelet concentrates (PC). MCS is a new blood cell separator that combines discontinuous flow features with a new computerized operating system and can be used to harvest either full units of apheresis PC (SDP _protocol) or half units of PC together with one to two units of plasma (PLP _protocol). On the average, 1.98 × 10¹¹ ± 0.46 × 10¹¹ (mean ± SD) platelets were obtained by the PLP protocol and 3.01 × 10¹¹ ± 0.70 × 10¹¹ and 4.2 × 10¹¹ ± 1.12 × 10¹¹ by the early and later versions of the SDP protocols, respectively. The mean number of WBC per PC ranged from 3.3 to 4.7 × 10⁸. During the storage period pH stayed above 7.0. On the average, the production of one molecule of lactate corresponded to the consumption of 0.538 molecules of glucose, indicating that less than 8% of glucose was consumed by the oxidative pathway. There were only small increases in LDH and B thromboglobulin concentrations. Furthermore, the ability of platelets to recover from osmotic shock and to aggregate following exposure to dual agonists declined only slightly during storage, indicating that both viability and function of platelets collected by the MCS were preserved during storage. © 1993 Wiley-Liss, Inc.     

Evaluation of a device to facilitate female urethral catheterization.

Urethral catheterization is a skilled procedure that nurses in hospital settings perform routinely. The opening of the female urethra is located within the vulvar vestibule, making insertion of urinary catheters into females a greater technical challenge than in males. Researchers evaluated whether a new device might decrease the time required for catheter insertion, increase the likelihood of inserting the catheter on the first attempt (improved accuracy), and reduce patient discomfort. Comments about the device from both patients and nurses also are reported.     

数字化乳腺X线成像系统技术进展

乳腺癌是常见的癌症之一，近年来其发病率呈上升趋势，已居我国沿海发达地区女性恶性肿瘤的首佗早期发现、早期诊断、早期治疗是目前降低乳腺癌病死率的关键。而乳腺X线摄影作为检测早期临床无症状隐匿性乳腺癌的重要手段，早已成为欧美国家公认的普查筛选的方法。据报道，乳腺X线摄影降低了约30％的50岁以上妇女的乳腺病     

Evaluation of a controlled-released membrane infusion device for delivery of gentamicin

A new controlled-release membrane infusion device has been developed which consists of a drug and a fluid chamber separated by a 0.2-microns proprietary membrane. Drug transfer is based on electrodiffusion across the membrane. The objective of this study was to determine the feasibility of using this device to achieve adequate serum concentrations of gentamicin in adult healthy volunteers. Ten subjects (age 20-40 years) received a single dose of gentamicin, 1.7 mg/kg through the device. Multiple blood samples were collected and gentamicin was measured by EMIT. Peak serum concentrations of gentamicin ranged from 4.8 to 10.5 micrograms/ml. The mean total clearance, apparent distribution volume and elimination half-life were 0.96 ml/min/kg, 0.16 l/kg and 1.9 h, respectively. No adverse events occurred. These data suggest that a simple membrane device can be used for gentamicin delivery using gravity flow. The device should be evaluated in patients to define its role in therapy.     

Evaluation of "HemoCue," a new device for determining hemoglobin

Hemoglobinometry according to the International Committee of Standardization in Hematology (ICSH) suffers from imprecision related to high sample dilution and from potential errors owing to sample turbidity. We have evaluated a new instrument, "HemoCue," that measures hemoglobin at two wavelengths as azide methemoglobin, without dilution. The HemoCue method is superior to the ICSH method: by correction for turbidity, it avoids false hemoglobin readings that may arise from hyperlipemia or some large M-component of the immunoglobulin M class. We find the equipment suitable for use in outpatient units.     

Evaluation of online course discussions. Faculty facilitation of active student learning

Graduate nursing faculty evaluated their initial experiences with online course discussions after making the transition from traditional use of weekly face-to-face classroom discussions to primarily computer-based interactions with students at distant sites. The online discussion data were analyzed qualitatively. The ways the faculty member communicated to facilitate active student involvement in the online discussions were coded. Six categories were identified that describe the ways the faculty member communicated to facilitate active student involvement in online discussions: assist with navigation, explain expectations, clarify faculty role, stimulate critical thinking, share expertise, and provide encouragement. Examples of each were provided to demonstrate ways faculty promoted student learning in online discussions.     

Evaluation of a Danish teaching program in breast self-examination

This study investigated the effect of a BSE training program on women's knowledge, attitudes, and behavior regarding BSE. Postal questionnaires were sent to 629 women who had participated in 1998-2000 in the BSE training program run by Ribe County, Denmark, and to a local matched control group of the same size selected through personal registration numbers. Response rates were 77% and 56%, respectively. A significantly greater number of women who had attended BSE training reported that they knew how and when to do BSE, and what they should do if they discovered breast changes (97% compared to 66% in control group). Similar proportions in each group felt confident of finding any breast changes (57%) and believed that routine BSE can influence the chances of recovery from breast cancer (90%). There were also no significant differences between the intervention and control groups in the reporting of anxiety as a result of performing BSE (24% and 17%, respectively). The intervention group was significantly more likely to perform BSE regularly (66% compared to 52% in control group) and to use a more correct technique (44% compared to 20% in control group). It was concluded that a formal training program increases the likelihood of regular BSE performance with a correct technique.