Ultrasound-guided, vacuum-assisted, percutaneous excision of breast lesions: an accurate technique in the diagnosis of atypical ductal hyperplasia

BACKGROUND: In October 2002, ultrasound-guided, vacuum-assisted, percutaneous excision was shown to facilitate the complete removal of benign breast lesions up to 3 cm in diameter. This study was performed to ascertain the overall accuracy of ultrasound-guided, vacuum-assisted, percutaneous excision as evidenced by the frequency of atypical ductal hyperplasia (ADH) underestimation. STUDY DESIGN: A retrospective review was conducted of 542 consecutive ultrasound-guided, vacuum-assisted breast biopsies performed between February 2000 and September 2004. Before July 2002, no attempt was made to completely remove all imaged lesion evidence. After July 2002, all patients underwent complete percutaneous excision of all imaged lesion evidence. Pathology review revealed 52 lesions that demonstrated ADH and no evidence of malignancy. Each patient with this diagnosis was offered surgical excision. Pathologic reports for each group were compared with the subsequent open surgical specimens. RESULTS: Of 542 consecutively diagnosed lesions, 52 displayed ADH with no evidence of malignancy (10%). Five patients refused operation. Of the 47 patients who underwent open excision, 6 (13%) were found to have malignancies. The rate of ADH underestimation was 6 of 18 (33%) in incisional biopsies and 0 of 29 performed with complete imaged lesion evidence (p=0.002). The rate of ADH underestimation in women who underwent ultrasound-guided, vacuum-assisted, percutaneous excision was zero, a result equivalent to open surgical biopsy. CONCLUSIONS: ADH is a more common finding in sonographic lesions than has been previously reported. Complete ultrasound-guided, vacuum-assisted, percutaneous excision is more accurate than nonexcisional ultrasound-guided biopsy. Patients so diagnosed have very low underestimation rates and may not require open surgical reexcision.     

Benzodiazepine use in older adults enrolled in a health maintenance organization.

OBJECTIVES: The authors examined patterns of benzodiazepine use in older adults. Specifically, they describe prevalence and incidence of benzodiazepine use during the index year, describe persistence and intensity of benzodiazepine use over a 4-year period; and examine factors associated with benzodiazepine use in the upcoming year. METHODS: Authors performed a secondary analysis of data collected as part of a health promotion intervention trial conducted from 1986 to 1992 in older health maintenance organization enrollees (N=1,505). Benzodiazepine use was ascertained from computerized pharmacy records. Demographic characteristics, health status, and health behaviors were ascertained from mailed questionnaires. RESULTS: During the index year, the prevalence and incidence of benzodiazepine use was 12.3% and 6.6%, respectively. Of those using during the index year, 16% of new users and 63% of previous users continued to use for the following 3 years. The factors significantly associated with benzodiazepine use in the following year were female gender, high school education, higher chronic disease score, higher levels of self-reported pain and stress, low-to-normal body mass index (BMI), and self-reported nervous disorder. CONCLUSIONS: New users had low intensity of use and a low probability of continuing use over the following 3 years. A very small percentage of this sample had evidence of daily use for 4 years. Of concern, benzodiazepines were used by the segment of the sample that were at greatest risk for hip fractures (women with normal/low BMI). Clinicians should assess the need for continued benzodiazepine use at regular intervals.     

How does overeaters anonymous help its members? A qualitative analysis

Overeaters Anonymous (OA) is a 12‐step, self‐help group for individuals who perceive themselves to have problems with compulsive overeating. Despite the popularity of OA and the frequent use of addictions‐based treatments for eating disorders, little is known about how OA is helpful. The purpose of this qualitative study was to explore members' experiences with and perceptions of OA. We conducted three focus groups with self‐selected members of OA (N = 20). We present three primary themes that emerged from the analysis of the focus groups' discussions, which emphasize why individuals entered OA, OA's ‘tools’, and how individuals perceived OA to ‘work’. Overall, although participants agreed OA was helpful to them, there was no consensus regarding how OA ‘works’. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

A(H1N1) pandemic influenza and its prevention by vaccination: Paediatricians' opinions before and after the beginning of the vaccination campaign

Background  

In June 2009, the World Health Organization declared an A(H1N1) influenza pandemic. In October 2009, the largest vaccination campaign in Canadian history began. The aim of this study was to document paediatricians' knowledge, attitudes and practices (KAP) regarding A(H1N1) pandemic influenza and its prevention by vaccination just after the beginning of the A(H1N1) vaccination campaign and to compare the results with those obtained before campaign initiation.     

Hypnotists' associations: A consumer's confusion

Hypnosis is practiced by a wide variety of professionals and lay people. The consumer typically has little information on which to base a decision about the utilization of a hypnotist's services. Although there is currently little legal regulation of hypnosis, there are many associations of hypnotists that have a variety of requirements for membership. A survey of all hypnotists' associations that could be contacted in the major cities of the United States was conducted in order to describe the method and degree of regulation of hypnotists through membership in the associations. In addition, an overview of the qualities of associated hypnotists were described in terms of their practice of hypnosis, their education and training, and the titles they used. Recommendations are made for assuring quality control in the use of hypnosis.