National Quality Measures for Breast Centers (NQMBC): a robust quality tool: breast center quality measures.

INTRODUCTION: Measuring and improving quality of care is of primary interest to patients, clinicians, and payers. The National Consortium of Breast Centers (NCBC) has created a unique program to assess and compare the quality of interdisciplinary breast care provided by breast centers across the country. METHODS: In 2005 the NCBC Quality Initiative Committee formulated their initial series of 37 measurements of breast center quality, eventually called the National Quality Measures for Breast Centers (NQMBC). Measures were derived from published literature as well as expert opinion. An interactive website was created to enter measurement data from individual breast centers and to provide customized comparison reports. Breast centers submit information using data they collect over a single month on consecutive patients. Centers can compare their results with centers of similar size and demographic or compare themselves to all centers who supplied answers for individual measures. New data may be submitted twice yearly. Serially submitted data allow centers to compare themselves over time. NQMBC random audits confirm accuracy of submitted data. Early results on several initial measures are reported here. RESULTS: Over 200 centers are currently submitting data to the NQMBC via the Internet without charge. These measures provide insight regarding timeliness of care provided by radiologists, surgeons, and pathologists. Results are expressed as the mean average, as well as 25th, 50th, and 75th percentiles for each metric. This sample of seven measures includes data from over 30,000 patients since 2005, representing a powerful database. In addition, comparison results are available every 6 months, recognizing that benchmarks may change over time. CONCLUSIONS: A real-time web-based quality improvement program facilitates breast center input, providing immediate comparisons with other centers and results serially over time. Data may be used by centers to recognize high-quality care they provide or to identify areas for quality improvement. Initial results demonstrate the power and potential of web-based tools for data collection and analysis from hundreds of centers who care for thousands of patients.

Case report 806: Monostotic Paget's disease of the hand (fifth metacarpal).

Monostotic Paget's disease of bone is an uncommon disease, reported in the hand in only a few instances. We have described an additional case involving a metacarpal bone in a 43-year-old man. We believe this disease should be considered in the radiological differential diagnosis of lytic expansile, subchondral lesions of the hand.

Silicone granuloma of the penis.

Injectable silicones have been applied to an undetermined number of men for penile augmentation. The practitioners of this art, whether lay or medical, have allegedly long discontinued treating penile size. In the literature to date, four men have been identified as having complications from this mode of therapy; three have had excisions of granulomatous masses secondary to the silicone; the third refused surgery. This paper reports an additional case of silicone granuloma of the penis, documented by biopsy, which necessitated two excisions to obtain a satisfactory size for copulation. Moreover, because of impotence, a Dow-Corning (Gerow design) penile prosthesis was inserted. The inflammatory response in this new case is identical to that found in other parts of the body, namely, multiple silicone droplets surrounded by multinucleated giant cells and chronic inflammatory cells.

Alpha-1-antitrypsin globules in hepatocytes of elderly persons with liver disease.

Percutaneous needle biopsy specimens of the liver from three elderly persons (aged 77, 71, and 66) demonstrated eosinophilic intracytoplasmic globules within hepatocytes, particularly in the periportal and periseptal areas. These globules were periodic acid-Schiff positive and diastase resistant, and were identified as alpha-1-antitrypsin by immunofluorescence technics. Two of the patients had cirrhosis, and identification of protease inhibitor (Pi) type by acid starch electrophoresis and crossed immunoelectrophoresis demonstrated SZ and MZ genotypes. The patient with SZ genotype also had a long history of chronic obstructive pulmonary disease. Pi-typing was not performed for the third patient, who did not have cirrhosis. The morphologic identification of alpha-1-antitrypsin disease in liver biopsies of persons of any age is important because of (1) possible multisystem involvement (hepatic and pulmonary), (2) increased frequency of hepatocellular carcinoma, and (3) implications for genetic counseling for other family members.

Blood lead levels in San Diego policemen.

Blood lead levels were measured by atomic absorption spectrophotometry in 86 San Diego policemen to see if they would reflect the known high atmospheric lead levels in San Diego. The mean blood lead for the entire group was 27.0 microgram per dl, a level very similar to that found in the general population of other cities. Work exposure to heavy traffic, area of residence, work shift and smoking did not significantly influence blood lead. Thus, an ambient atmospheric lead load ranging from 2 to 5 microgram per cubic m does not demonstrably cause higher blood lead levels in persons exposed to such air. Surprisingly, the youngest group, 21 to 25 years, had the highest mean (32.2 microgram per dl) while the oldest, 46 to 55 years, had the lowest mean (20.9 microgram per dl), a difference statistically highly significant. However, length of work as a policeman per se did not influence blood lead levels. Exposure to other known high-risk factors (hobbies, ceramics, old dwellings) was associated with higher levels (mean 30.6 microgram per dl).