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1.
Breast Cancer Res ; 24(1): 55, 2022 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-35907862

RESUMO

BACKGROUND: Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2). METHODS: Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset. RESULTS: 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84-87%; 1776/2072) and specificity 86% (95%CI 85-86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86-91%) and higher specificity (2957/3298; 90%; 95%CI 89-91%) than Group 2 (sensitivity = 83%; 95%CI 81-85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81-83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68-0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45-0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90-89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88-89%) and Group 2 (83-84%). CONCLUSIONS: Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.


Assuntos
Neoplasias da Mama , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Mamografia/métodos , Estudos Prospectivos , Sensibilidade e Especificidade
2.
Br J Radiol ; 92(1104): 20190663, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31559859

RESUMO

OBJECTIVES: To assess whether NHS breast screening programme (NHSBSP) mammogram readers could effectively interpret first post-contrast acquisition subtracted (FAST) MRI, for intended use in screening for breast cancer. METHODS: Eight NHSBSP mammogram readers from a single centre (four who also read breast MRI (Group 1) and four who do not (Group 2)) were given structured FAST MRI reader training (median 4 h: 32 min). They then prospectively interpreted 125 FAST MRIs (250 breasts: 194 normal and 56 cancer) comprising a consecutive series of screening MRIs enriched with additional cancer cases from 2015, providing 2000 interpretations. Readers were blinded to other readers' opinions and to clinical information. Categorisation followed the NHSBSP MRI reporting categorisation, with categories 4 and 5 considered indicative of cancer. Diagnostic accuracy (reference standard: histology or 2 years' follow-up) and agreement between readers were determined. RESULTS: The accuracy achieved by Group 2 (847/1000 (85%; 95% confidence interval (CI) 82-87%)) was 5% less than that of Group 1 (898/1000 (90%; 95% CI 88-92)). Good inter-reader agreement was seen between both Group 1 readers (κ = 0.66; 95% CI 0.61-0.71) and Group 2 readers (κ = 0.63; 95% CI 0.58-0.68). The median time taken to interpret each FAST MRI was Group 1: 34 s (range 3-351) and Group 2: 77 s (range 11-321). CONCLUSION: Brief structured training enabled multiprofessional mammogram readers to achieve similar accuracy at FAST MRI interpretation to consultant radiologists experienced at breast MRI interpretation. ADVANCES IN KNOWLEDGE: FAST MRI could be feasible from a training-the-workforce perspective for screening within NHSBSP.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Confiabilidade dos Dados , Imageamento por Ressonância Magnética/métodos , Mamografia , Radiologistas/educação , Intervalos de Confiança , Meios de Contraste , Feminino , Humanos , Estudos Prospectivos , Padrões de Referência , Sensibilidade e Especificidade , Fatores de Tempo
3.
Psychiatr Q ; 87(4): 605-618, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-26687294

RESUMO

This study explored (1) the incidence of posttraumatic stress disorder (PTSD) resulting from past trauma among older patients with COPD and (2) whether PTSD and COPD severity would relate to psychiatric co-morbidity and health-related quality of life. Eighty-five older patients completed the Hospital Anxiety and Depression Scale, the Chronic Respiratory Questionnaire, the Posttraumatic Stress Diagnostic Scale and the Medical Outcomes Short Form 12. The results showed that 55, 39 and 6 % had no, partial and full-PTSD respectively. Partial least squares showed that PTSD was significantly correlated with COPD severity which in turn was significantly correlated with health-related quality of life and psychiatric co-morbidity. Mediational analysis showed that the emotional symptoms of COPD mediated between PTSD and the mental health functioning of health-related quality of life and between PTSD and depression. To conclude, PTSD from past trauma was related to the severity of COPD for older patients. In particular, it impacted on the elevated emotional arousal of COPD severity. In turn, COPD severity impacted on older patients' general psychological well-being and depression.


Assuntos
Trauma Psicológico/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Idoso , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Trauma Psicológico/psicologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Reino Unido/epidemiologia
4.
J Cardiopulm Rehabil Prev ; 29(1): 49-56, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19158588

RESUMO

PURPOSE: Posttraumatic stress disorder (PTSD) is a common serious condition, which, although treatable, is often undetected. We investigated the prevalence of PTSD in patients with chronic obstructive pulmonary disease (COPD) referred to pulmonary rehabilitation and the impact of rehabilitation on PTSD symptoms. METHODS: Patients with COPD attending pulmonary rehabilitation programs in South West England completed cross-sectional and longitudinal surveys. Outcome measures included the Posttraumatic Diagnostic Scale, Impact of Events scale, Incremental Shuttle Walking Test, Medical Outcomes Short Form 12, Hospital Anxiety and Depression scale (HADS), and Chronic Respiratory Questionnaire. Questionnaires were completed at face-to-face interviews with participants 1 week before commencing pulmonary rehabilitation and at the end of the program. RESULTS: Patients (N = 100), mean age 68 years, 65% men, served as subjects. Seventy-four participants reported traumatic experiences (37 related to lung disease) and 70 completed the pulmonary rehabilitation program. Eight of 100 participants met diagnostic criteria for PTSD. Participants with PTSD reported worse health status than those without PTSD. After pulmonary rehabilitation, exercise capacity and quality of life scores improved significantly, but PTSD symptom severity did not change. CONCLUSIONS: PTSD was present in 8% of COPD patients referred for pulmonary rehabilitation. After rehabilitation, participants with PTSD improved more in respect to anxiety and disease-specific health status than those without PTSD. PTSD symptoms did not improve following rehabilitation, despite its positive effects on HADS scores, exercise, and health status in this cohort.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adaptação Psicológica , Idoso , Tolerância ao Exercício , Feminino , Humanos , Modelos Lineares , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Psicometria , Qualidade de Vida , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/etiologia , Inquéritos e Questionários , Reino Unido/epidemiologia
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