Hepatocellular carcinoma (HCC) versus non-HCC: accuracy and reliability of Liver Imaging Reporting and Data System v2018

Abdominal Radiology - The Liver Imaging Reporting and Data System (LI-RADS) was created to standardize the diagnostic criteria for hepatocellular carcinoma (HCC) and has undergone multiple...     

Violence in a pediatric emergency department: lessons learned from one experience

A multitude of forces influence the probability of violence in an emergency department, but none impact as directly as the skilled response of the emergency nurse. It is important not to overlook the availability of security and law enforcement, but it may be equally important for nurses to take appropriate steps toward preventing or solving such problems with a minimum of physical and emotional pain for all concerned. With time and practice, incidents of violence can be replaced with opportunities for growth and healing.     

Comparison of Contrast-Enhanced Ultrasound versus Contrast-Enhanced Magnetic Resonance Imaging for the Diagnosis of Focal Liver Lesions Using the Liver Imaging Reporting and Data System

The aim of this retrospective study was to evaluate the Liver Imaging Reporting and Data System (LI-RADS) categorization of focal liver lesions (FLLs) on contrast-enhanced ultrasound (CEUS) in comparison with contrast-enhanced magnetic resonance imaging (CE-MRI). A total of 63 patients with 84 FLLs were included in the final study population, after review of the electronic medical records and clinical data. Two trained radiologists evaluated all CEUS and CE-MRI images independently. They assigned a LI-RADS category to each FLL and assessed major features based on CEUS LI-RADS Version 2017 and computed tomography/MRI LI-RADS Version 2018. The generalized estimating equation method was used to compare the diagnostic performance of the LI-RADS algorithm between CEUS and CE-MRI. The sensitivity of LR-5/LR-TIV (tumor in vein) categories for diagnosing hepatocellular carcinoma (HCC) differed significantly between CEUS and CE-MRI (88.9% [40/45], 95% confidence interval [CI]: 76.5%–95.2%), versus 64.4% (29/45; 95% CI: 49.8%–76.8%), p = 0.006; 82.2% (37/45; 95% CI: 68.7%–90.7%), versus 62.2% (28/45; 95% CI: 47.6%–74.9%), p = 0.034. Inter-observer agreement was substantial for assigning LR-5 on both CEUS and CE-MRI. For both reviewers, there was a higher frequency of LR-5 (44.0% vs. 25.0%, p = 0.009; 42.9% vs. 26.2%, p = 0.023) in CEUS compared with CE-MRI. Arterial phase hyper-enhancement (APHE) was less frequently observed on CEUS than on CE-MRI (46.4% vs. 61.9%, p = 0.044). However, the washout appearance was observed more frequently on CEUS than on CE-MRI (50.0% vs. 28.6%, p = 0.004). Inter-observer agreement between the two reviewers on APHE and washout appearance was excellent for both CEUS and CE-MRI. These findings suggest that CEUS had a much higher sensitivity than CE-MRI in the diagnosis of HCC using LI-RADS, and although the frequencies of major features differed, inter-observer agreement between the two reviewers on major features of HCC was excellent for both CEUS and CE-MRI.     

Neonatal nursing care issues following a natural disaster: lessons learned from the Katrina experience

The massive evacuation of sick and at-risk infants from a large metropolitan area following a natural disaster provides many lessons for neonatal nurses. Planning and education are of utmost importance, and disaster education and training are essential for all nurses. Unit-specific disaster plans can serve as a guide for nurses but the real test occurs during and after the event. Nurses must learn to adapt neonatal care to the rapidly changing environment during a disaster. Supporting high-risk infants without the aid of technology requires a back-to-the-basics approach. The ability to maintain communication and facilitate transportation of neonates out of a disaster area is essential. Nurses must also consider their own well-being in the aftermath of a disaster. Planning for future disasters should include lessons learned from the past events. This article addresses nursing care issues and lessons learned from the events that unfolded in the New Orleans area neonatal units during and after Hurricane Katrina, and guidance in support of disaster education for neonatal nurses.     

乳腺病变超声乳腺影像报告和数据系统(BI-RADS)诊断一致性的评估

目的 评价不同乳腺超声经验评估者使用超声乳腺影像报告和数据系统(BI-RADS)诊断乳腺超声图像的一致性.方法 12位评估者独立评估30个已获病理诊断的乳腺病变的超声图像,得出诊断分级.计算κ值评估一致性、诊断阳性预测值(PPV)和阴性预测值(NPV).结果 乳腺超声经验丰富的评估者BI-RADS 3、4、5级κ值分别为0.72、0.28和0.60,3级的NPV为93%,5级的PPV为97%,上述结果均随超声经验的减少而下降.结论 乳腺超声经验丰富的评估者使用BI-RADS可提供准确和一致的诊断,但诊断一致性随乳腺超声经验的减少而下降.     

Operational and resource management of an RCT: some of the pitfalls and lessons learned

Nurses frequently fulfil important functions within a research team involved in clinical trials. This paper describes the challenges inherent in developing and managing a large clinical trial involving the evaluation of homoeopathy and asthma. Teamwork, a clear and comprehensive understanding of the research protocol, marketing the project, and the ability to manage human resources within both a primary and secondary care environment are all essential aspects of clinical research. Our experience in establishing and managing this project has suggested to us that a high standard of clinical research demands an open approach to problem-solving as well as the realization that efficient research is as much about the management of people as it is about scientific rigour.     

Pearls and pitfalls of community-based group interventions for adolescents: lessons learned from an adolescent asthma cAMP study

This paper explores specific challenges in implementing community-based group interventions with adolescents and makes practical suggestions to researchers who contemplate the group approach. Group interventions have important implications for adolescent research and program development in the area of chronic illness. They have a capacity to address participants' psychosocial needs as well as to offer a cost and time-effective opportunity for disease-specific education. A group intervention encompasses an array of pragmatic challenges that need to be addressed through meticulous preparation. Based on the authors' firsthand experience with a group intervention for adolescents with asthma, this paper describes potential difficulties and logistics pertaining to recruitment, planning and implementation of a group intervention targeting adolescents and suggests general strategies that can be adopted.     

Computer aided classification system for breast ultrasound based on Breast Imaging Reporting and Data System (BI-RADS)

Clinically, the ultrasound findings are evaluated by its sonographic characteristics and then assigned to assessment categories according to the definitions of Breast Imaging Reporting and Data System (BI-RADS) developed by the American College of Radiology. In this study, a computer-aided classification (CAC) system was proposed to classify the masses into assessment categories 3, 4 and 5, which simulated the clinical diagnosis of radiologists. Compared with current computer-aided diagnosis systems, the proposed CAC system classifies the indeterminate cases into BI-RADS category 4 for further diagnosis. Six hundred twenty-six cases were collected from three ultrasound systems and confirmed by pathology and retrospectively classified into categories 3, 4 and 5 by radiologists. The multinomial logistic regression model was trained as the CAC system for predicting the assessment category from the computerized BI-RADS features and from a set of machine-dependent factors. By using the machine-dependent factors to indicate the adopted ultrasound systems, the same regression model could be applied for the cases acquired from different ultrasound systems. A basic CAC system was trained by using the classification result of radiologists. A weighted CAC system, to improve the capacity of the basic CAC system in differentiating benign from malignant lesions, was trained by adding the pathologic result. Between the radiologists and the basic CAC system, a substantial agreement was indicated by Cohen's kappa statistic and the differences in either the performance indices or the A(Z) of receiver operating characteristic (ROC) analysis were not statistically significant. For the weighted CAC system, the performance indices accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73.00% (457 of 626), 98.17% (215 of 219), 59.46% (242 of 407), 56.58% (215 of 380) and 98.37% (242 of 246), respectively; the A(Z) was 0.94; and the correlation with the radiologists was also substantial agreement. The indices accuracy and specificity of weighted CAC system, compared with those of the radiologists, were improved by 5.91% and 8.85%, respectively and the indices of sensitivity and NPV, compared with those of a conventional CAD system, were improved by 10.5% and 5.21%, respectively; all improvements were statistically significant. To classify the mass into BI-RADS assessment categories by the CAC system is feasible. Moreover, the proposed CAC system is flexible because it can be used to diagnose the cases acquired from different ultrasound systems.     

Oversight and management of a cell therapy clinical trial network: experience and lessons learned

The Cardiovascular Cell Therapy Research Network (CCTRN), sponsored by the National Heart, Lung, and Blood Institute (NHLBI), was established to develop, coordinate, and conduct multiple collaborative protocols testing the effects of cell therapy on cardiovascular diseases. The Network was born into a difficult political and ethical climate created by the recent removal of a dozen drugs from the US formulary and the temporary halting of 27 gene therapy trials due to safety concerns. This article describes the Network's challenges as it initiated three protocols in a polarized cultural atmosphere at a time when oversight bodies were positioning themselves for the tightest vigilance of promising new therapies. Effective strategies involving ongoing education, open communication, and relationship building with the oversight community are discussed.     

Multiple systems organ failure (MSOF): lessons learned from the adult respiratory distress syndrome (ARDS)

The relationship between ARDS and MSOF is explored. Models include that ARDS represents only one organ failing in MSOF, or that MSOF is a complication of ARDS owing to the development of infection and sepsis syndrome in these patients. Data are reviewed suggesting an important role of infection and sepsis syndrome in both models.     

对职业超声医师应用乳腺影像报告与数据系统分类的倡议

正从20世纪70年代B超应用于乳腺,先后经历了灰阶(即黑白)超声、多普勒超声(包括彩色多普勒血流成像)、超声造影及弹性成像等重大技术进步,这些超声影像技术发挥的作用不言而喻,时至今日,仍是国内外临床应用和学术研究的热点。与CT、磁共振成像(magnetic resonance imaging,MRI)等影像技术相比,超声具有局限性的检查切面、任意性的检查操作及主观性的结果判断等特点,     

Spiritual-care process and content: lessons learned from the ECHO Project

PURPOSE: To describe the process and content of spiritual caregiving delivered by a minister to 18 homeless male addicts in recovery and to determine whether and how advanced practice nurses can integrate similar counseling into practice. DATA SOURCES: Notes from the minister's clinical sessions with individuals in the study sample were analyzed to identify the procedures used in spiritual counseling and the overall content of the interactions. Results were then reviewed in light of the literature on the nurse's role in spiritual caregiving to determine realistic implications for practice. IMPLICATIONS FOR PRACTICE: Advanced practice nurses are currently mandated to integrate spiritual care into clinical practice as part of their holistic-practice model. Although theoretically sound, in practice, the time-dependent and specialized nature of spiritual caregiving may be more appropriately and effectively delivered by ministers as part of the primary care team when time, personal, and other constraints exist.     

Additional Value of Superb Microvascular Imaging for Thyroid Nodule Classification with the Thyroid Imaging Reporting and Data System

Superb microvascular imaging (SMI) is an innovative vascular imaging technique for ultrasound (US). Compared with conventional color Doppler imaging (CDI) and power Doppler imaging (PDI), SMI can detect more blood flow in thyroid nodules. In this study, a total of 203 thyroid nodules (160 benign nodules, 43 malignant nodules) in 195 patients were assessed with the Thyroid Imaging Reporting and Data System (TI-RADS) published by the American College of Radiology in 2017) and SMI. With TI-RADS alone, 24 (15.0%), 76 (47.5%), 65 (40.6%) and 39 (24.4%) thyroid nodules were classified as TR2, TR3, TR4 and TR5, respectively. However, with the combination of TI-RADS and SMI, 31 (19.4%), 79 (49.4%), 44 (27.5%) and 49 (30.6%) thyroid nodules were classified as TR2, TR3, TR4 and TR5, respectively. The area under the receiver operating characteristic curves for the combination (0.952) was larger than that for TI-RADS alone (0.883) (Z = 3.478, p = 0.001). The efficiency of TI-RADS alone and the TI-RADS + SMI combination in diagnosing thyroid nodules was determined for all except TR2 nodules. Although no significant differences between the methods were observed for TR3 and TR5 thyroid nodules (p > 0.05), the diagnostic efficiency of TI-RADS + SMI for TR4 thyroid nodules was higher than that of TI-RADS alone for TR4 nodules (p < 0.05). This study indicated that the vascularity of thyroid nodules can be well characterized using SMI, and the combined use of gray-scale US and SMI can improve the diagnostic performance of TI-RADS for TR4 thyroid nodules.     

Training on Reporting and Data System (RADS) for Somatostatin-Receptor Targeted Molecular Imaging Can Reduce the Test Anxiety of Inexperienced Readers

Molecular Imaging and Biology - For somatostatin receptor (SSTR)-positron emission tomography/computed tomography (PET/CT), a standardized framework termed SSTR-reporting and data system (RADS) has...     

Implementation of Cardovascular Cell Therapy Network trials: challenges,innovation and lessons learned from experience in the CCTRN

The cardiovascular cell therapy network was developed by the National Heart, Lung and Blood Institute to design and conduct clinical trials to advance the field of cardiovascular (CV) cell-based therapy. The Cardiovascular Cell Therapy Network successfully completed three clinical trials involving approximately 300 subjects across five centers and six satellites. Although the concept of a network within clinical trials research is not new, the knowledge gained in the implementation of such large-scale trials, particularly in novel therapeutic areas such as cell therapy is not often detailed in the literature. The purpose of this communication is to summarize key factors in achieving network goals and share the knowledge gained to promote success in future cardiovascular disease cell therapy trials and networks.