Reduction in Thyroid Nodule Biopsies and Improved Accuracy with American College of Radiology Thyroid Imaging Reporting and Data System.

Purpose To compare the biopsy rate and diagnostic accuracy before and after applying the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) criteria for thyroid nodule evaluation. Materials and Methods In this retrospective study, eight radiologists with 3-32 years experience in thyroid ultrasonography (US) reviewed US features of 100 thyroid nodules that were cytologically proven, pathologically proven, or both in December 2016. The radiologists evaluated nodule features in five US categories and provided biopsy recommendations based on their own practice patterns without knowledge of ACR TI-RADS criteria. Another three expert radiologists served as the reference standard readers for the imaging findings. ACR TI-RADS criteria were retrospectively applied to the features assigned by the eight radiologists to produce biopsy recommendations. Comparison was made for biopsy rate, sensitivity, specificity, and accuracy. Results Fifteen of the 100 nodules (15%) were malignant. The mean number of nodules recommended for biopsy by the eight radiologists was 80 ± 16 (standard deviation) (range, 38-95 nodules) based on their own practice patterns and 57 ± 11 (range, 37-73 nodules) with retrospective application of ACR TI-RADS criteria. Without ACR TI-RADS criteria, readers had an overall sensitivity, specificity, and accuracy of 95% (95% confidence interval [CI]: 83%, 99%), 20% (95% CI: 16%, 25%), and 28% (95% CI: 21%, 37%), respectively. After applying ACR TI-RADS criteria, overall sensitivity, specificity, and accuracy were 92% (95% CI: 68%, 98%), 44% (95% CI: 33%, 56%), and 52% (95% CI: 40%, 63%), respectively. Although fewer malignancies were recommended for biopsy with ACR TI-RADS criteria, the majority met the criteria for follow-up US, with only three of 120 (2.5%) malignancy encounters requiring no follow-up or biopsy. Expert consensus recommended biopsy in 55 of 100 nodules with ACR TI-RADS criteria. Their sensitivity, specificity, and accuracy were 87% (95% CI: 48%, 98%), 51% (95% CI: 40%, 62%), and 56% (95% CI: 46%, 66%), respectively. Conclusion ACR TI-RADS criteria offer a meaningful reduction in the number of thyroid nodules recommended for biopsy and significantly improve the accuracy of recommendations for nodule management. © RSNA, 2018 Online supplemental material is available for this article.

Interobserver Variability of Sonographic Features Used in the American College of Radiology Thyroid Imaging Reporting and Data System.

OBJECTIVE: The purpose of this study was to assess interobserver variability in assigning features in the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) lexicon and in making recommendations for thyroid nodule biopsy. MATERIALS AND METHODS: The study cohort comprised 100 nodules in 92 patients who underwent fine-needle aspiration with definitive cytologic results (Bethesda category II or VI) or diagnostic lobectomy between April 2009 and May 2010. Eight board-certified radiologists evaluated the nodules according to the five feature categories that constitute ACR TI-RADS and gave a biopsy recommendation based on their own practice. Variability in feature assignment and biopsy recommendation was assessed with the Fleiss kappa statistic. RESULTS: Agreement in interpretation was fair to moderate for all features except shape (κ = 0.61) and macrocalcifications (κ = 0.73), which had substantial agreement. The features with the poorest agreement were margin and other types of echogenic foci, which had kappa values ranging from 0.25 to 0.39, indicating fair agreement. Interobserver agreement regarding biopsy recommendation was fair (κ = 0.22) based on radiologists' current practice. Applying ACR TI-RADS resulted in moderate agreement (κ = 0.51). CONCLUSION: Variability in interpreting thyroid nodule sonographic features was highest for margin and all types of echogenic foci, except for macrocalcifications. Because radiologists' interpretations of these features change the level of suspicion of thyroid malignancy, the results of this study suggest a need for further education. Despite the variability in assigning features, adoption of ACR TI-RADS improves agreement for recommending biopsy.

Fractured penis.

PURPOSE: To provide nurse practitioners (NP) with information concerning the uncommon occurrence of penile fracture, a review of the anatomy and physiology of the penile shaft, signs and symptoms to be included in assessment, diagnostic tests, treatment, and referral are discussed. DATA SOURCES: Current literature available in journals and textbook, and clinical experience. CONCLUSIONS: Penile fracture, although an uncommon incident, is an urgent condition that requires a urology consult and surgical repair. IMPLICATIONS FOR PRACTICE: Because of the serious nature of this injury and the potential for complications, NPs need to obtain an urgent urology consult when penile fracture is suspected or diagnosed. The characteristic typical clinical presentation usually eliminates the need for expensive or invasive tests for diagnosis.

The acute, nontraumatic scrotum: assessment, diagnosis, and management.

PURPOSE: This article reviews the acute, nontraumatic scrotal conditions of testicular torsion, torsion of an epididymal or testicular appendage, and epididymitis in order to assist the nurse practitioner (NP) with arriving at a diagnosis. Primary and emergency care management are presented. DATA SOURCES: Selected published literature in refereed journals and the authors' clinical experiences. CONCLUSIONS: Signs and symptoms of testicular pathologies can overlap, making diagnosis problematic. However, key features can raise the NP's index of suspicion for a particular diagnosis and can assist in selecting the most appropriate management strategy. IMPLICATIONS FOR PRACTICE: Although these conditions are rarely fatal, they may carry a risk of morbidity in the form of testicular necrosis, infarction, or atrophy with concomitant infertility. Any patient with scrotal or testicular pain should be presumed to have testicular torsion until proven otherwise, as this condition carries a high degree of morbidity. The information gained through a thorough history and physical examination can assist in arriving at the proper diagnosis.

A human centered GeoVisualization framework to facilitate visual exploration of telehealth data: a case study.

PURPOSE: Public health data is typically organized by geospatial units. Routine geographic monitoring of health data enables an understanding of the spatial patterns of events in terms of causes and controls. GeoVisualization (GeoVis) allows users to see information hidden both visually and explicitly on a map. Despite the applicability of GeoVis in public health, it is still underused for visualizing public health data. The objective of this study is to examine the perception of telehealth users' to utilize GeoVis as a proof of concept to facilitate visual exploration of telehealth data in Brazil using principles of human centered approach and cognitive fit theory. METHODS: A mixed methods approach combining qualitative and quantitative assessments was utilized in this cross sectional study conducted at the Telehealth Center of the Federal University of Pernambuco (NUTE-UFPE), Recife, Brazil. A convenient sample of 20 participants currently involved in NUTES was drawn during a period of Sep-Oct 2011. Data was gathered using previously tested questionnaire surveys and in-person interviews. Socio-demographic Information such as age, gender, prior education, familiarity with the use of computer and GeoVis was gathered. Other information gathered included participants' prior spatial analysis skills, level of motivation and use of GeoVis in telehealth. Audio recording was done for all interviews conducted in both English and Portuguese, and transcription of the audio content to English was done by a certified translator. Univariate analysis was performed and means and standard deviations were reported for the continuous variables and frequency distributions for the categorical variables. For the open-ended questions, we utilized a grounded theory to identify themes and their relationship as they emerge from the data. Analysis of the quantitative data was performed using SAS V9.1 and qualitative data was performed using NVivo9. RESULTS: The average age of participants was 28 years (SD=7), a majority of them were females and 100% were professionals with graduate degrees. The users had diverse backgrounds including nursing, computer science, biomedical informatics, statistics, dentistry, administration and engineering. The users had varied roles and responsibilities, used computers frequently but only 5% of them were familiar with GeoVis. Google maps were the most common GeoVis application that the users were familiar with. Despite having minimal spatial skills, there was a strong motivation and relevance among the telehealth users to use GeoVis to facilitate visual exploration of telehealth data for better informed decision making. Results also showed that of the 60% participants with no GeoVis familiarity; 33% had moderate to large data exploratory role, 83% had no spatial skills but 58% preferred analyzing both spatial and temporal dimensions of the data. Majority of the participants agreed to have maps as the first choice to represent the data as it will be able to display the events both in place and time. DISCUSSION: The results demonstrate a potentially growing need for the use of GeoVis applications to evaluate telehealth data. Understanding of user needs is essential to ensure that the technology is appropriately functional and will be useful to complete the tasks.

Designing human centered GeoVisualization application--the SanaViz--for telehealth users: a case study.

BACKGROUND: Public health data is typically organized by geospatial unit. GeoVisualization (GeoVis) allows users to see information visually on a map. OBJECTIVES: Examine telehealth users' perceptions towards existing public health GeoVis applications and obtains users' feedback about features important for the design and development of Human Centered GeoVis application "the SanaViz". METHODS: We employed a cross sectional study design using mixed methods approach for this pilot study. Twenty users involved with the NUTES telehealth center at Federal University of Pernambuco (UFPE), Recife, Brazil were enrolled. Open and closed ended questionnaires were used to gather data. We performed audio recording for the interviews. Information gathered included socio-demographics, prior spatial skills and perception towards use of GeoVis to evaluate telehealth services. Card sorting and sketching methods were employed. Univariate analysis was performed for the continuous and categorical variables. Qualitative analysis was performed for open ended questions. RESULTS: Existing Public Health GeoVis applications were difficult to use. Results found interaction features zooming, linking and brushing and representation features Google maps, tables and bar chart as most preferred GeoVis features. CONCLUSIONS: Early involvement of users is essential to identify features necessary to be part of the human centered GeoVis application "the SanaViz".

Evaluation of a tele-education programme in Brazil.

We evaluated a tele-education programme for primary care staff in Pernambuco State, Brazil. During 2008 and 2009, tele-education sessions occurred four times each week for one hour per day. The topics included public health, child and adolescent health, mental health and nursing. After each session, participants completed an evaluation questionnaire. A total of 73 municipalities and 141 health centres participated in the programme. There were 254 tele-education sessions scheduled during the 20-month study period; of these, 224 sessions were successfully performed and 30 were cancelled. We collected 3504 responses from the satisfaction survey. There was high acceptance of the programme: 97% rated it as excellent or good.

Adding story-centered care to standard lifestyle intervention for people with Stage 1 hypertension.

This study examined the blood pressure (BP)-lowering effect of adding story-centered care (i.e., carefully attending to another's narrative) to standard lifestyle intervention (i.e., exercise training and nutrition counseling) for people with Stage 1 hypertension. The subjects (N = 24), who were university and hospital employees, were unmedicated and received standard lifestyle intervention; half were randomly assigned to story-centered care. Their 24-hour BP was measured four times at 8-week intervals, twice before and twice after the intervention. Subjects who received story-centered care had greater decreases (p < .05) in awake systolic BP over the 6-month study period. Neither systolic nor diastolic sleep BP was significantly affected. Story-centered care showed promise for contributing to the BP-lowering effect of lifestyle intervention. Approaches for integrating story-centered care into the treatment of people with hypertension are challenging but warrant further attention.