Women's responses to information on mammographic breast density.

The objective of this study was to determine the negative and positive outcomes of providing mammographic breast density (MBD) information to participants of a screening program. A randomized experiment was conducted with a sample of 618 women 50 years or older with MBD greater than 50% of breast volume. The intervention consisted of reporting the presence of MBD in the screening mammography results letter that was sent along with an information pamphlet. Compared to the controls, more women in the intervention group described the term breast density correctly and recognized it as a risk factor for breast cancer. Although at the 4-week follow-up the intervention group indicated that they were "very likely" to have an annual clinical breast examination more frequently than controls, no differences were detected at 6 months. There were no significant differences on other behavioural or psychological measures, although at the 4-week follow-up the control group perceived their risk for breast cancer, relative to other women their age, as "a lot lower" than did women in the intervention group. The results demonstrate a feasible and non-threatening way to provide women with important personalized information about breast cancer risk.     

Mammographic density as a risk factor of breast cancer

Mammographic density refers to the presence of fibroglandular tissue in the breast. Several studies including our study in which quantitative methods of were used for assessing breast density have demonstrated a positive association with breast cancer risk. Most studies yielded an odds ratio of 4 or greater for the most dense compared with the least dense breast tissue category. Mammographic density is of interest in assessing the etiology of breast cancer, but it may also have potential as a surrogate marker of risk in interventions designed to reduce the risk of breast cancer.     

Angular velocity: a new method to improve prediction of ventricular fibrillation duration

Ventricular fibrillation (VF) is a leading cause of sudden death. Electrical defibrillation is the primary modality of treatment, but evidence is accumulating that its use in the late stage of VF prior to providing ventilation, chest compressions and the administration of appropriate medication is detrimental. In VF of <5 min duration a 'shock first' strategy is effective. In VF of 5> min duration a 'perfuse first' approach is more effective. Because of the difficulty in determining the duration of VF in the clinical setting we have sought to develop method which analyze 5 s intervals of VF waveform and quickly provide an estimate of duration. Such methods would be useful in directing clinical interventions. Using methods of nonlinear dynamics and fractal geometry we have previously derived a quantitative measure of VF duration, namely the scaling exponent (ScE). In this study we report on a novel method also based on nonlinear dynamics, the angular velocity (AV). By constructing a flat, circular disk-shaped structure in a three-dimensional phase space and measuring the velocity of rotation of the position vector over time, a statistic is developed which rises from 58 rad/s at 1 min to 79 rad/s at 4 min and then decreases in a linear manner to 32 rad/s at 12.5 min. Using ScE and AV probability density estimated, VF of <5 min duration can be identified with 90% sensitivity on the basis of a single 5 s recording of the waveform. The combination of ScE and AV can be used in developing strategies for the treatment of VF during the different clinical phases of VF.     

乳腺密度与乳腺癌风险

乳腺密度反映乳腺X线片上乳腺组成成分,以致密组织所占百分比来表示。近年来有大量关于乳腺密度与乳腺癌风险的研究,虽然不少放射学者质疑这些研究大部分存在方法学上的缺陷,但近10年来越来越多的主流杂志认可致密乳腺与乳腺癌的强相关性。由于致密乳腺在人群中占相当大的比例,乳腺密度如被确定为乳腺癌的独立强相关因子,必将会对临床实践和卫生经济政策产生很大的影响。因此,对于两者相关性的研究应建立在更可靠的乳腺密度测量、乳腺密度分级及对致密乳腺更标准化的定义之上。数字化乳腺X线成像及数字乳腺断层融合X线成像的普及推广将对乳腺密度的研究有极大帮助。     

乳腺癌X线诊断误诊病例分析

本文收集我院2000～2002年间经手术病理证实的271例乳腺癌病例,术前均行高频X线摄片,现对其中28例误诊病例的原因进行分析,以期将误诊病例减少至最少,并进一步提高诊断水平。1材料与方法28例均为已婚女性,年龄30～79岁,平均46岁。20例触及肿块;2例肿块并单孔溢血;1例单孔溢血;1例疼痛并腺体片状增厚;2例良性病变术后各1年、2年,疤痕处出现肿块;2例全乳发硬、发热并疼痛,局部皮肤发红。除4例皮肤可见改变外,其余病例均无皮肤、乳头改变,均未扪及腋下肿大淋巴结。采用意大利GittoHI-TECH高频X线乳腺机,Agfa单面药膜增感屏暗盒及乳腺摄片专…     

Deep-LIBRA: An artificial-intelligence method for robust quantification of breast density with independent validation in breast cancer risk assessment

Breast density is an important risk factor for breast cancer that also affects the specificity and sensitivity of screening mammography. Current federal legislation mandates reporting of breast density for all women undergoing breast cancer screening. Clinically, breast density is assessed visually using the American College of Radiology Breast Imaging Reporting And Data System (BI-RADS) scale. Here, we introduce an artificial intelligence (AI) method to estimate breast density from digital mammograms. Our method leverages deep learning using two convolutional neural network architectures to accurately segment the breast area. An AI algorithm combining superpixel generation and radiomic machine learning is then applied to differentiate dense from non-dense tissue regions within the breast, from which breast density is estimated. Our method was trained and validated on a multi-racial, multi-institutional dataset of 15,661 images (4,437 women), and then tested on an independent matched case-control dataset of 6368 digital mammograms (414 cases; 1178 controls) for both breast density estimation and case-control discrimination. On the independent dataset, breast percent density (PD) estimates from Deep-LIBRA and an expert reader were strongly correlated (Spearman correlation coefficient = 0.90). Moreover, in a model adjusted for age and BMI, Deep-LIBRA yielded a higher case-control discrimination performance (area under the ROC curve, AUC = 0.612 [95% confidence interval (CI): 0.584, 0.640]) compared to four other widely-used research and commercial breast density assessment methods (AUCs = 0.528 to 0.599). Our results suggest a strong agreement of breast density estimates between Deep-LIBRA and gold-standard assessment by an expert reader, as well as improved performance in breast cancer risk assessment over state-of-the-art open-source and commercial methods.     

乳腺实质X线分型与乳腺癌相关性分析

目的探讨乳腺实质x线分型与乳腺癌相关性,对乳腺癌高危人群实行干预性治疗和定期追查,达到降低乳腺癌发生率和死亡率的目的。方法对500例乳腺癌和1000例对照组病例进行乳腺x线分型,将对照组不同亚型组织切片与乳腺癌组癌周组织切片对照研究,分析乳腺不同亚型乳腺癌的危险度,同时分析乳腺不同亚型在各年龄段发生乳腺癌的危险度。并通过统计学方法作类型分析和乳腺癌发生统计。结果①最低危险组OR〈0．3,癌发生率在2％以下的亚型有Ⅰa,Ⅱa,Ⅲa,Ⅳa。②低危险组OR〈0．3,癌发生率在2％～5％以下的亚型是Ⅰb型。③危险组OR〉0．3癌发生率在5～10％的亚型：Ⅰb,Ⅱb,Ⅲb,Ⅳb。④高危险组OR〉I,癌发生率超过10％以上的亚型Ⅲc,Ⅳc。乳腺癌高危险年龄段：Ⅳc型和Ⅲc型35～55岁,Ⅲc型可延长至60岁,IVb型31—50岁,Ⅲb和Ⅱb型50～60岁。结论Ⅲc和Ⅳc型属于高危险型,其人群约占癌数的67．4％。是乳腺普查追踪的主要对象,其中35—55岁必须每年复查一次。必要时进行干预性治疗,达到预防乳腺癌,降低乳腺癌发生率及早发现早治疗,提高乳腺癌患者的生存质量,降低死亡率。     

Establishment of seminars to improve the diagnostic accuracy and effectiveness of breast ultrasound

Purpose To improve the ability of technicians and physicians to find and diagnose breast lesions in breast ultrasound screening. Methods Seminars were organized for technicians and physicians engaged in breast ultrasound screening, and tests were carried out to evaluate the usefulness of the seminars. Each seminar lasted 2 days and comprised lectures and group activities. Pretests and post-tests conducted before and after each seminar, respectively, consisted of 100 questions: 50 about animated images, and 50 about static images. The tests required the participant to find lesions in animated images and estimate the probability of malignancy from static images. Results In the animated image tests, sensitivity was greater after the seminar, although specificity did not change significantly. In the static image tests, sensitivity increased, and a significant increase was also observed in the receiver operating curve analysis for degree of certainty in diagnosing cancer. Conclusion The seminars improved the participants' ability to find and diagnose breast lesions during ultrasound screening.     

Using within-patient correlation to improve the accuracy of shock outcome prediction for cardiac arrest

BACKGROUND: Analysis of the electrocardiogram (ECG) can to a certain extent predict if a cardiac arrest patient in ventricular fibrillation will get return of spontaneous circulation (ROSC) if defibrillated. The accuracy of such methods determines how useful it is clinically and for retrospective analysis. METHODS AND RESULTS: We have tested the accuracy of a new shock outcome prediction algorithm that is the first to use an updating algorithm capable of learning from previous shocks within a resuscitation effort. The algorithm relies on known predictive features from the pre-shock ECG, but for each delivered shock it re-estimates the patient-dependent relationship between predictive feature value and probability of ROSC by incorporating the information from the already performed shocks. The predictive features mean-slope, median-slope, cardioversion-outcome-predictor and amplitude-spectrum-analysis originally had areas under the receiver operating characteristics curve of 0.843, 0.846, 0.837 and 0.819, respectively. The improvements in areas after applying the algorithm were (bootstrap estimate of mean improvement, 95% confidence interval in parentheses): mean-slope, 0.019 (0.00036, 0.042); median-slope, 0.024 (0.0013, 0.048); cardioversion-outcome-predictor, 0.021 (0.0010, 0.051); amplitude-spectrum-analysis, 0.026 (0.0016, 0.051). The predictions for the first shock to each patient were not included when calculating the areas, as for the first shocks the new algorithm has no previous shocks to learn from and give predictions identical to those of the original features. CONCLUSIONS: It is possible to improve current shock prediction methods by using an updating algorithm capable of learning from previous shocks within a resuscitation effort.     

Identifying approaches to improve the accuracy of shock outcome prediction for out-of-hospital cardiac arrest

BACKGROUND: Analysis of the electrocardiogram (ECG) can predict if a cardiac arrest patient in ventricular fibrillation is likely to have a return of spontaneous circulation if defibrillated. The accuracy of such methods determines how useful it is clinically and for retrospective analysis. METHODS AND RESULTS: We wanted to identify if there is a potential of improving prediction accuracy by adding peri-arrest factors to an ECG-based prediction system, or constructing a prediction system that adapts to each patient. Therefore, we analysed shock outcome prediction data with a mixed effects logistic regression model to identify if there are random effects (unexplained variation between patients) influencing the prediction accuracy. We also added information about the patients' age, sex and presenting rhythm, ambulance response time and presence of bystander CPR to the model to try to improve it by reducing the random effects. For all the six predictive features analysed random effects where present, with p-values below 10(-3). The random effect size was 73-189% of the feature effect size. Adding the peri-arrest factors to the best ECG-based model gave no significant improvement. CONCLUSIONS: The presence of random effects shows that the shock outcome prediction accuracy can be improved by explaining more of the variation between patients, for example using the approaches outlined above, and that there is within-patient correlation between samples that should be accounted for when evaluating prediction accuracy. The specific peri-arrest factors tested here did not significantly improve prediction accuracy, but other factors should be explored.     

乳腺微小钙化在乳腺癌诊断中的意义

目的探讨钼靶乳腺摄影对乳腺微小钙化在不同乳腺疾病中的诊断价值。方法回顾性分析212例乳腺X线钼靶片显示微小钙化病例,全部经手术病理证实,其中乳腺恶性病变131例,良性病变81例。采用9项指标分析钙化,运用χ2检验评价各项指标对乳腺癌的诊断价值。结果微小钙化判断乳腺癌最有价值的指标为:①每平方厘米微小钙化数目(N/S)>20;②微小钙化总数目>30;③钙化点间密度不均、大小不一;④钙化形态为细沙型、混合型、蠕虫样或粗颗粒型;⑤微小钙化合并肿块;⑥如合并肿块钙化灶分布于肿块内外。结论乳腺X线片中微小钙化形态学表现、密度、大小、数目及合并肿块对乳腺癌的诊断具有重要价值。     

Adjustment issues related to bilateral prophylactic mastectomy in women at elevated risk of developing breast cancer.

Breast cancer is the most common cancer diagnosis for North American and Western European women. Increased knowledge in availability of genetic testing has helped to identify those women at high risk of eventually developing breast cancer. This has resulted in more women considering bilateral prophylactic mastectomy as a viable preventative option. Although the efficacy of the procedure has been established, much less is known about the psychological impact of undergoing this procedure. In order to assess these factors, we reviewed what is currently known about the psychological impact of undergoing bilateral prophylactic mastectomy. Searches were conducted and inclusion criteria revealed articles that focused on the psychological components involved with undergoing a bilateral prophylactic mastectomy. The findings are summarized and fell broadly into one or more of the following three areas: (1) satisfaction or regret following the surgery, (2) psychosocial functioning after the surgery, and (3) predictors of quality of life. Plastic surgery nurses have a unique opportunity to impact important psychological considerations, such as expectations of the early postoperative period, body image concerns, and psychological distress.     

A hybrid method to improve target registration accuracy in surgical navigation

Background: The accuracy of surgical navigation depends greatly on that of registration between the patient and the medical image. Point-based registration has been the most common and reliable method, which typically uses skin markers. Unfortunately, high registration accuracy around the markers is not sustained at targets deeply seated within the body. To address such increase in target registration error (TRE), we proposed a hybrid point-based registration method that incorporates anatomical landmarks near the target. Material and methods: Ultrasound calibration is performed with an optical tracker for coordinate frame conversion of image coordinates into the real world. With the calibrated ultrasound probe, we could non-invasively obtain landmark positions near the target, being used together with skin markers for registration. Results: In the experiment, we examined registration accuracies achieved with and without use of an anatomical landmark. We confirmed that using an additional anatomical landmark in registration resulted in an increase in fiducial regsitration error (FRE), but a significant decrease in TRE (p < 0.001). Conclusion: We proposed and demonstrated the effectiveness of a hybrid method that uses both artificial and anatomical landmarks for patient-to-image registration. The experimental results confirmed that an improvement in TRE was evident by the proposed method, suggesting its feasibility in various spinal surgeries.     

运用卓越教学法提升临床护士的健康教育能力

[目的]探索运用卓越教学法提高临床护士健康教育能力的方法。[方法]分析目前健康教育存在的问题,将国外先进的卓越教学原则引入临床健康教育工作中,为护士提供更为系统的健康教育程序,将“以病人为中心”的目标贯穿于整个健康教育过程中,通过健康教育能力自我评价及满意度评价效果。[结果]通过培训,责任护士对健康宣教的计划性、引导性、关爱性更强,更注重了解病人的个体本身,为病人提供更为个性化的健康宣教内容与方式,护士的自信心、责任感明显增强;且培训后病人满意度明显提高。[结论]应用卓越教学法能更好地提升临床护士的健康教育能力。     

运用QCC方法提高静脉输液速度正确率

目的运用QCC方法提高门诊静脉输液速度正确率。方法成立QCC小组,培训QCC圈员,选定活动主题,进行现状调查,分析静脉输液速度不正确的原因,制订相应对策,实施10个月并持续质量改进。结果门诊静脉输液速度正确率由原来的86.89%提高到99.78%。结论 QCC活动能明显提高门诊静脉输液速度正确率,让患者享受优质安全的医疗服务。