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1.
Artigo em Inglês | MEDLINE | ID: mdl-38762704

RESUMO

Editing services within academic health centers are uncommon, and few studies have reported on their impact. In this article, we describe our medical writing center's editing service for faculty and trainees at a pediatric teaching hospital and associated outcomes of scholarly products (e.g., manuscripts and grants) over an 8-year period. Data for manuscripts and grant proposals edited by the writing center from 2015 through 2022 were collected electronically from our service request database. Outcome data on publications and grant proposals were regularly collected up to 12 months post-submission. Users were also asked if the writing center edits were helpful, improved readability, and if they planned to use the service in the future. From 2015 through 2022, the writing center received 697 requests, 88.4% to edit a document. Of the documents edited, 81.3% of manuscripts and 44.4% of grant proposals were successfully published or funded. When rating their experience, 97.8% of respondents rated the edits "helpful," 96.7% indicated the edits "improved readability," and 99.3% stated they planned to use the writing center in the future. Our results showed steady use of the writing center and high satisfaction with services. A writing center can be an effective tool to support psychology faculty development.

2.
J Vet Emerg Crit Care (San Antonio) ; 32(S1): 72-80, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35044064

RESUMO

BACKGROUND: Abdominocentesis is commonly used to evaluate the abdominal cavity of the horse. This technique provides valuable diagnostic information as well as the means to monitor patients with abdominal diseases being managed medically and to determine their need for surgical management. Complications are uncommon and include trauma to the gastrointestinal tract or spleen, septic peritonitis, or abdominal wall infection. PROCEDURES: This review describes the indications, utility, patient preparation, and instructions for performing abdominocentesis as well as possible complications reported in horses. Step-by-step instructions are provided for the two most commonly used abdominocentesis techniques in horses, which include the use of a needle (18 Ga, 3.8 cm [1.5 in]) and a teat cannula (9.5 cm [3.75 in]). SUMMARY: Peritoneal fluid collection and fluid analysis can be used to confirm diagnosis of intraabdominal pathology including inflammatory, infectious, neoplastic, obstructive, and bowel strangulation, leading to additional diagnostic and therapeutic plans. KEY POINTS: Abdominocentesis is useful as a diagnostic procedure in horses suffering from colic, diarrhea, weight loss, or other conditions involving the abdominal cavity and is an integral component of diagnostic testing for colic at referral institutions or in the field. Abdominal fluid collection using an 18-Ga, 3.8-cm (1.5-in) needle is recommended for adult horses because the needle is long enough to penetrate the peritoneal cavity. The teat cannula technique is recommended for use in adult horses, foals, and miniature horses to reduce the risk of enterocentesis, even though this procedure is more traumatic than using an 18-Ga, 3.8-cm needle. Ultrasonography of the abdomen is a valuable tool in the assessment of any horse with signs of colic, but it is not essential for performing an abdominocentesis successfully.


Assuntos
Cólica , Doenças dos Cavalos , Peritonite , Abdome , Animais , Líquido Ascítico , Cólica/veterinária , Doenças dos Cavalos/diagnóstico , Cavalos , Peritonite/diagnóstico , Peritonite/veterinária
3.
Vet Surg ; 50(2): 273-282, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33331004

RESUMO

OBJECTIVE: To report the outcome of horses used in western performance disciplines after deep branch lateral plantar neurectomy/fasciotomy surgery for hind limb proximal suspensory desmopathy (PSD). STUDY DESIGN: Retrospective analysis. SAMPLE POPULATION: Twenty-one client-owned horses. METHODS: Medical records were reviewed (2009-2019) for horses involved in western performance disciplines that had been treated with deep branch lateral plantar neurectomy and plantar fasciotomy for lameness due to hind limb PSD. Follow-up was obtained by reexamination and/or verbal interviews with owners >2 years postoperatively. RESULTS: Sixteen quarter horses and five paints were used for western pleasure (14/21), barrel racing (2/21), cutting (1/21), steer wrestling (1/21), working cow horse (1/21), team roping (1/21) and reining (1/21). A median duration of 8 months was required before horses were able to resume training or athletic work. Nine horses were able to return to a similar or higher level of athletic use, nine horses returned to a lower level of athletic performance, and three horses could not return to intended function. Owner satisfaction with outcome after the procedure was high (16/21), average (3/21), and low (2/21). CONCLUSION: Deep branch lateral plantar neurectomy and plantar fasciotomy allowed most horses to resume some athletic function as western performance horses. CLINICAL SIGNIFICANCE: These results provide evidence of potential outcomes when considering surgical treatment of hind limb PSD in western performance horses.


Assuntos
Denervação/veterinária , Fasciíte Plantar/veterinária , Membro Posterior/patologia , Doenças dos Cavalos/cirurgia , Ligamentos/patologia , Nervo Tibial/cirurgia , Animais , Denervação/estatística & dados numéricos , Fasciíte Plantar/cirurgia , Feminino , Membro Posterior/cirurgia , Cavalos , Ligamentos/cirurgia , Masculino , Estudos Retrospectivos , Nervo Tibial/patologia , Resultado do Tratamento
4.
J Neurol Surg B Skull Base ; 81(1): 37-42, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32021748

RESUMO

Objective The main purpose of this article is to determine the frequency of neurotologic complications after posterior fossa microvascular decompression (MVD) surgery. Design Retrospective case review. Setting Tertiary care referral center. Participants A total of 215 consecutive MVD operations by a single surgeon between March 1996 and May 2016 were reviewed with 192 surgeries on 183 patients meeting inclusion criteria. Main Outcome Measures Neurotologic complications secondary to MVD. Results The 52 males and 131 females had a mean age of 58.52 years (range, 28-92 years). Indications for MVD were trigeminal neuralgia ( n = 162), hemifacial spasm ( n = 23), glossopharyngeal neuralgia ( n = 13), vagal palsy ( n = 1), and tinnitus ( n = 1). The outcomes examined were postoperative hearing loss, tinnitus, vertigo, and hemifacial paresis. At least one of these complications was present in 17.7% of patients. There were 4.17% with permanent hearing loss, 6.77% with transient hearing loss, 5.21% with tinnitus, 5.73% with vertigo, and 0.52% with hemifacial paresis. There was no significant difference in complication rates based on surgical indication. Conclusions Neurotologic complications are a significant risk when performing MVD. It is important for otolaryngologists as well as neurosurgeons to be aware of such complications. We recommend perioperative audiometry in all patients undergoing MVD and believe there is utility in routine otolaryngologist involvement.

5.
Equine Vet J ; 52(6): 799-804, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31994775

RESUMO

BACKGROUND: Obesity is common in the equine population and it has been associated with increased surgical morbidity and mortality in humans. The effect of increased body mass index (BMI) on the incidence of surgical site infections has not been investigated in horses. OBJECTIVES: To determine whether horses with increased body fat, as estimated by BMI, are more likely to develop post-operative complications, particularly incisional complications, following emergency ventral midline celiotomy. STUDY DESIGN: Retrospective, multi-institutional clinical study. METHODS: Medical records of horses >2 years old presenting with colic that underwent ventral midline celiotomy between January 2010 and September 2018 with follow-up of a minimum of 30 post-operative days were reviewed. Extracted data included signalment, operative details and outcome. BMI was calculated by dividing the patient's weight (kg) by the withers height squared (m2 ). RESULTS: In all, 287 horses fit inclusion criteria. Incisional complication prevalence was 23.7%. Horses with incisional complications had a higher BMI (median 203.6 kg/m2 , IQR = 191.5-217.4) compared with those without (median 199.1 kg/m2 , IQR = 184.7-210.2) (P = .03). Multi-variable analysis of the effects of age, sex, breed and presence of metabolic disease on the association between BMI and risk of incisional complications, identified a tendency towards increased risk with a higher BMI, but statistical significance decreased to P = .07. Breed had an association with BMI (P < .01), but not with incisional complication risk. MAIN LIMITATIONS: BMI as an estimate of body fat has limitations. Retrospective studies with reliance on owners reporting data and complete medical records is imperfect. When the data were subjected to multi-variable analysis, the trend towards an increased incidence of incisional complications in horses with higher BMI persisted but it was not statistically significant. CONCLUSION: Higher BMI may increase the risk for the development of incisional complications in horses following emergency ventral midline celiotomy.


Assuntos
Cólica , Doenças dos Cavalos , Animais , Índice de Massa Corporal , Cólica/cirurgia , Cólica/veterinária , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/etiologia , Doenças dos Cavalos/cirurgia , Cavalos , Humanos , Laparotomia/veterinária , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos
6.
BMJ Open ; 9(11): e032081, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31772096

RESUMO

It is common to undertake qualitative research alongside randomised controlled trials (RCTs) when evaluating complex interventions. Researchers tend to analyse these datasets one by one and then consider their findings separately within the discussion section of the final report, rarely integrating quantitative and qualitative data or findings, and missing opportunities to combine data in order to add rigour, enabling thorough and more complete analysis, provide credibility to results, and generate further important insights about the intervention under evaluation. This paper reports on a 2 day expert meeting funded by the United Kingdom Medical Research Council Hubs for Trials Methodology Research with the aims to identify current strengths and weaknesses in the integration of quantitative and qualitative methods in clinical trials, establish the next steps required to provide the trials community with guidance on the integration of mixed methods in RCTs and set-up a network of individuals, groups and organisations willing to collaborate on related methodological activity. We summarise integration techniques and go beyond previous publications by highlighting the potential value of integration using three examples that are specific to RCTs. We suggest that applying mixed methods integration techniques to data or findings from studies involving both RCTs and qualitative research can yield insights that might be useful for understanding variation in outcomes, the mechanism by which interventions have an impact, and identifying ways of tailoring therapy to patient preference and type. Given a general lack of examples and knowledge of these techniques, researchers and funders will need future guidance on how to undertake and appraise them.


Assuntos
Estudos de Avaliação como Assunto , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Humanos
7.
BMJ Open ; 9(8): e026289, 2019 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-31467046

RESUMO

OBJECTIVES: Physical rehabilitation is a complex process, and trials of rehabilitation interventions are increasing in number but often report null results. This study aimed to establish treatment success rates in physical rehabilitation trials funded by the National Institute of Health Research Health Technology Assessment (NIHR HTA) programme and examine any relationship between treatment success and the quality of intervention development work undertaken. DESIGN: This is a mixed methods study. SETTING: This study was conducted in the UK. METHODS: The NIHR HTA portfolio was searched for all completed definitive randomised controlled trials of physical rehabilitation interventions from inception to July 2016. Treatment success was categorised according to criteria developed by Djulbegovic and colleagues. Detailed textual data regarding any intervention development work were extracted from trial reports and supporting publications and informed the development of quality ratings. Mixed methods integrative analysis was undertaken to explore the relationship between quantitative and qualitative data using joint displays. RESULTS: Fifteen trials were included in the review. Five reported a definitive finding, four of which were in favour of the 'new' intervention. Eight trials reported a true negative (no difference) outcome. Integrative analysis indicated those with lower quality intervention development work were less likely to report treatment success. CONCLUSIONS: Despite much effort and funding, most physical rehabilitation trials report equivocal findings. Greater focus on high quality intervention development may reduce the likelihood of a null result in the definitive trial, alongside high quality trial methods and conduct.


Assuntos
Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Pesquisa de Reabilitação , Reabilitação , Humanos , Avaliação das Necessidades , Avaliação de Resultados em Cuidados de Saúde , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Reabilitação/métodos , Reabilitação/organização & administração , Reabilitação/normas , Pesquisa de Reabilitação/métodos , Pesquisa de Reabilitação/normas , Avaliação da Tecnologia Biomédica/métodos , Resultado do Tratamento , Reino Unido
8.
Vet Surg ; 48(5): 890-896, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30729544

RESUMO

OBJECTIVE: To describe the surgical treatment and short- and long-term outcome of young pot-bellied pigs with penile prolapse. STUDY DESIGN: Short case series. ANIMALS: Five young castrated Vietnamese pot-bellied pigs. METHODS: Five Vietnamese pot-bellied pigs presented with penile prolapse of several weeks duration. No other abnormalities were found at physical examination. Under general anesthesia, phallopexy with or without combined urethropexy was performed successfully in all cases. RESULTS: All pigs were discharged from the hospital. One pig required a second urethropexy the day after the initial surgery to improve positioning of the penis in the prepuce. Long-term outcome was available in 4 cases. Penile prolapse resolved in the 4 cases available for follow-up, and the owners were satisfied with the cosmetic outcome of the procedure. CONCLUSION: Penile prolapse was successfully corrected in 5 pot-bellied pigs by using 2 different phallopexy techniques. The procedure was combined with urethropexy in 3 pigs. Long-term outcome was excellent in the 4 cases available for follow-up. CLINICAL IMPACT: This is the first report describing the use of phallopexy with or without urethropexy for successful treatment of penile prolapse in young pot-bellied pigs. Two different phallopexy techniques were effectively used in this report. The etiology of penile prolapse in pot-bellied pigs remains unknown.


Assuntos
Doenças do Pênis/veterinária , Doenças dos Suínos/cirurgia , Animais , Masculino , Doenças do Pênis/patologia , Doenças do Pênis/cirurgia , Prolapso , Suínos , Uretra/cirurgia
9.
Acad Radiol ; 26(1): 118-129, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30076084

RESUMO

RATIONALE AND OBJECTIVES: Adverse reactions to intravenous contrast for radiologic examinations can result in significant patient morbidity and mortality. It is critical that radiologists be proficient at recognizing and treating reactions in a timely and appropriate manner. Therefore, we developed a hands-on simulation curriculum to improve residents' ability and comfort in recognizing and responding to contrast reactions. MATERIALS AND METHODS: Contrast reaction management simulations were performed in 2016 and 2017 with 25 and 26 resident participants, respectively. Participants completed pre- and postsimulation surveys both years to assess knowledge and comfort in managing contrast reactions. RESULTS: In 2016, 25 participants answered 12 questions assessing knowledge of contrast reaction management. Percentage of correct answers increased from pre- to postsurvey in 83% of questions (10/12). Participants indicated their comfort level in managing contrast reactions increased on all six questions from pre- to postsurvey. In 2017, 26 participants answered 14 questions assessing knowledge of contrast reaction management. Similarly, percentage of correct answers increased from pre- to postsurvey in 86% of questions (12/14). Participant comfort levels also increased on all six questions from pre- to postsurvey. Subgroup analysis performed on 19 participants who completed the curriculum both years demonstrated further improvement in knowledge and comfort after completing the second year, showing added benefit of repeated simulation. CONCLUSION: These results suggest that incorporating high-fidelity contrast reaction management simulation into resident education improves both residents' knowledge and comfort in managing reactions. We have therefore incorporated annual contrast reaction simulation as a standard component of our residency curriculum.


Assuntos
Meios de Contraste/efeitos adversos , Treinamento com Simulação de Alta Fidelidade , Internato e Residência/métodos , Radiologia/educação , Competência Clínica , Currículo , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Autoeficácia , Inquéritos e Questionários
10.
Radiol Case Rep ; 14(2): 260-264, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30510608

RESUMO

A 60-year-old male presented with complaints of dyspnea, intermittent fever, and 40 pounds of weight loss over the previous 9 months and was admitted for acute hypoxemic respiratory failure. Labs demonstrated elevated inflammatory markers, mild anemia, and thrombocytopenia. Fluorodeoxyglucose-positron emission tomography scan demonstrated diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding abnormality on CT images. Excisional lung biopsy demonstrated intravascular large B-cell lymphoma (IV-LBCL). Presentation, imaging findings, and diagnosis of IV-LBCL will be discussed, as well as differential considerations for pulmonary involvement by IV-LBCL.

11.
Acad Radiol ; 26(7): 893-899, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30318287

RESUMO

RATIONALE AND OBJECTIVES: To evaluate radiologic and pathologic features associated with upgrade of atypical ductal hyperplasia (ADH) to ductal carcinoma in situ or invasive breast cancer at surgical excision, in order to identify patients who may consider alternatives to excision. MATERIALS AND METHODS: This retrospective analysis examined patients who underwent surgical excision of biopsy-proven ADH at our institution. Imaging and pathology from biopsy were reviewed to determine radiologic (lesion size, radiologic abnormality, biopsy type, needle gauge, number of cores, percent of lesion removed) and pathologic features (histologic calcifications, presence of necrosis, micropapillary features, extent of ADH) associated with ADH upgrade. RESULTS: One hundred twenty four cases of percutaneous biopsy-proven ADH with subsequent excision were included. The overall upgrade rate was 17.7% (n = 22), with 17 cases to ductal carcinoma in situ and five to invasive cancer. Radiologic features associated with a lower upgrade rate were smaller lesion size (p = 0.032) and larger percent of lesion removed at biopsy (p = 0.047). Larger needle gauge at biopsy (p = 0.070), absence of necrosis (p = 0.051) and focal ADH (<3 foci, p = 0.12) were nearly associated with a lower rate of upgrade and were included for the purpose of multi parameter analyses. CONCLUSION: For women with ADH identified on percutaneous biopsy, the risk of upgrade may in part be determined by lesion size, percent of lesion removed at biopsy, presence of necrosis, and extent of ADH. Using a combination of these radiographic and pathologic features to stratify patients with biopsy-proven ADH may help identify women who could be considered for alternative treatment options.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Idoso , Biópsia com Agulha de Grande Calibre/instrumentação , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Humanos , Glândulas Mamárias Humanas/patologia , Pessoa de Meia-Idade , Necrose/diagnóstico por imagem , Necrose/patologia , Agulhas , Gradação de Tumores , Estudos Retrospectivos , Carga Tumoral
12.
J Vet Diagn Invest ; 30(6): 955-961, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30345891

RESUMO

Carcinosarcomas are biphasic malignant tumors composed of 2 distinct neoplastic cell populations, epithelial cells and mesenchymal cells. A 13-y-old, female, mixed-breed goat was presented with a 1-wk history of anuria and lethargy. Transabdominal ultrasonography showed an irregular and heterogeneous structure in the region of the bladder and uterus and changes in the echogenicity of both kidneys. Given the poor prognosis, euthanasia was elected. Autopsy revealed a large mass within the uterine cervix and confirmed the changes in the urinary tract. Histopathology and immunohistochemistry revealed a mixed, anti-cytokeratin AE1/AE3-positive epithelial, and vimentin-positive mesenchymal neoplasm consistent with a homologous carcinosarcoma, also called malignant mixed Müllerian tumor, with areas of double-labeling. We highlight the complexity of the diagnosis of uterine neoplasms in domestic animals and in goats in particular.


Assuntos
Doenças das Cabras/diagnóstico , Tumor Mulleriano Misto/veterinária , Neoplasias Uterinas/veterinária , Animais , Diagnóstico Diferencial , Feminino , Doenças das Cabras/patologia , Doenças das Cabras/cirurgia , Cabras , Imuno-Histoquímica/veterinária , Tumor Mulleriano Misto/diagnóstico , Tumor Mulleriano Misto/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
13.
J Digit Imaging ; 31(6): 776-782, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29869010

RESUMO

Increasing radiologic exam volume and complexity necessitates leveraging advanced hardware solutions to optimize workflow efficiency. We evaluated radiologist satisfaction of a programmable 13-button non-conventional mouse compared to a conventional three-button mouse in daily interpretation workflow following a brief 2-day trial period. A prospective study was conducted with radiology staff and residents in a tertiary care center from 2015 to 2016. A survey was distributed prior to and after a tutorial and a 2-day non-conventional mouse trial period. The post-survey evaluated usage time, device settings, satisfaction, preferences, and perceived efficiency of both mice. Descriptive analyses, correlations, the Sign test, and the Wilcoxon signed-rank test were used to evaluate responses. Fifty-nine participants completed pre- and post-surveys. Several (41%, n = 24) had prior experience with a non-conventional mouse. Prior to the trial, one third of all participants (35.6%, n = 21) reported being satisfied or very satisfied with their conventional mouse. After spending an average of 9.8 h using the non-conventional mouse, there were no statistically significant changes in overall satisfaction with either conventional or non-conventional mice (p = 0.84 and p = 0.39, respectively). However, 76.3% (n = 45) agreed/somewhat agreed they preferred to use the non-conventional mouse in their daily workflow as opposed to the conventional mouse. The non-conventional mouse was also perceived as more efficient (66.1%, n = 39), required less time (62.7%, n = 37) and effort (74.6%, n = 44) to view images, allowed for easier manipulation of windows/images (76.3%, n = 45), and was more comfortable to use (78.0%, n = 46). Although there were no statistically significant shifts in overall satisfaction, participants reported a higher level of satisfaction, perceived efficiency, and preference for a non-conventional 13-button mouse compared to a conventional three-button mouse following a brief, 2-day trial period.


Assuntos
Interpretação de Imagem Assistida por Computador/instrumentação , Satisfação Pessoal , Radiologistas/estatística & dados numéricos , Radiologia/instrumentação , Interface Usuário-Computador , Estudos de Coortes , Eficiência , Desenho de Equipamento , Feminino , Humanos , Masculino , Estudos Prospectivos , Fluxo de Trabalho
14.
Acad Radiol ; 25(12): 1577-1581, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29661602

RESUMO

RATIONALE AND OBJECTIVES: This study aimed to determine the average time for breast radiologists of varied experience to interpret automated breast ultrasound (ABUS) examinations. MATERIALS AND METHODS: A reader performance study was conducted on female patients, with ACR BI-RADS 4 breast density classifications of C or D, who received both an ABUS screening examination and a digital mammogram from 2013 to 2014 at an academic institution. Three faculty breast radiologists with varied levels of ABUS experience (advanced, intermediate, novice) read all ABUS examinations, with interpretation times and final impressions (categorized as "normal" or "abnormal") recorded for each examination. RESULTS: Ninety-nine patients were included, with all readers demonstrating an average ABUS interpretation time of less than 3 minutes. Compared to the other two readers, the intermediate reader had a significantly longer mean interpretation time at 2.6 minutes (95% confidence interval 2.4-2.8; P < .001). In addition to having the shortest mean interpretation time, the novice reader also demonstrated reduced times in subsequent interpretations, with a significant decrease in interpretation times of 3.1 seconds (95% confidence interval 0.4-5.8) for every 10 ABUS examinations interpreted (P < .05). CONCLUSIONS: Overall, mean ABUS interpretation time by radiologists of all experience levels was short, at less than 3 minutes per examination, which should not deter radiologists from incorporating ABUS examinations into a busy clinical environment.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Radiologia , Ultrassonografia Mamária , Idoso , Densidade da Mama , Competência Clínica , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Retrospectivos , Fatores de Tempo
15.
J Vasc Interv Radiol ; 29(5): 688-694, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29398411

RESUMO

PURPOSE: To determine whether treating benign biliary strictures via a stricture protocol reduced the probability of developing symptomatic recurrence and requiring surgical revision compared to nonprotocol treatment. MATERIALS AND METHODS: A stricture protocol was designed to include serial upsizing of internal/external biliary drainage catheters to a target maximum dilation of 18-French, optional cholangioplasty at each upsizing, and maintenance of the largest catheter for at least 6 months. Patients were included in this retrospective analysis if they underwent biliary ductal dilation at a single institution from 2005 to 2016. Forty-two patients were included, 25 women and 17 men, with an average age of 51.9 years (standard deviation ± 14.6). Logistic regression models were used to determine the probability of symptomatic recurrence and surgical revision by stricture treatment type. RESULTS: Twenty-two patients received nonprotocol treatment, while 20 received treatment on a stricture protocol. After treatment, 7 (32%) patients in the nonprotocol group experienced clinical or laboratory recurrence of a benign stricture, whereas only 1 patient in the stricture protocol group experienced symptom recurrence. Patients in the protocol group were 8.9 times (95% confidence interval [CI] = 1.4-175.3) more likely to remain symptom free than patients in the nonprotocol group. Moreover, patients in the protocol group had an estimated 89% reduction in the probability of undergoing surgical revision compared to patients receiving nonprotocol treatment (odds ratio = .11, 95% CI = .01-.73). CONCLUSIONS: Establishing a stricture protocol may decrease the risk of stricture recurrence and the need for surgical revision when compared to a nonprotocol treatment approach.


Assuntos
Colestase/cirurgia , Protocolos Clínicos , Drenagem/métodos , Cateterismo/instrumentação , Constrição Patológica , Dilatação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
J Natl Black Nurses Assoc ; 29(2): 36-39, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31022338

RESUMO

The World Health Organization (WHO) has identified obesity as a global health threat that has nearly tripled since 1975 (WHO, 2018). In 2016, of the 7.4 billion people in the world, more than 1.9 billion adults 18 years of age and older, were overweight. African-Americans were 1.4 times as likely to be obese as non-Hispanic Whites. Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health (WHO, 2018). The risk factors associated with obesity are cardiovascular, musculoskeletal, and cancer disorders (WHO, 2018). Policies that are currently in place addressing obesity are centered on nutrition, physical exercise, and parental involvement. The evidence shows that balanced diets and exercise could lead to healthy outcomes.


Assuntos
Saúde Global/estatística & dados numéricos , Obesidade/epidemiologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Humanos , Obesidade/etnologia , Fatores de Risco , Organização Mundial da Saúde
17.
AJR Am J Roentgenol ; 210(1): W22-W28, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29045183

RESUMO

OBJECTIVE: Supplemental screening with ultrasound has been shown to detect additional breast malignancies in women with dense breast tissue and normal mammogram findings. The frequency of supplemental screening with automated breast ultrasound and the effect and type of breast tissue density notification on automated screening breast ultrasound utilization rates are unknown. MATERIALS AND METHODS: We examined normal mammogram results letters for patients with heterogeneously or extremely dense breast tissue between July 1, 2013, and June 30, 2014, by type of results letter, notification method, and sociodemographic characteristics. Logistic regression was used to examine the association between type of results letter and subsequent automated screening breast ultrasound. RESULTS: Among 3012 women with dense breast tissue and normal mammogram findings, 15% returned for supplemental automated screening breast ultrasound within 18 months of results letter notification. Compared with a similarly sized control group of women who did not undergo automated ultrasound, a significantly greater proportion of patients (86.9%) returned for breast ultrasound if they received a results letter indicating breast density in combination with a courtesy phone call (p < 0.001). Patients who received results letters with breast density notification including a statement that they may benefit from additional screening with automated breast ultrasound examination were 9.91 times (95% CI, 6.08-16.16) more likely to return for the examination than patients who did not receive breast density notification or mention of supplemental screening. CONCLUSION: Patient breast density notification and radiologists' recommendations for supplemental screening with breast ultrasound increase patient utilization of automated screening breast ultrasound examinations.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico por imagem , Comunicação , Detecção Precoce de Câncer , Aceitação pelo Paciente de Cuidados de Saúde , Ultrassonografia Mamária , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Preferência do Paciente , Estudos Retrospectivos , Fatores Socioeconômicos
18.
J Infus Nurs ; 40(6): 359-363, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29112583

RESUMO

The goal of this study was to determine the best method for localizing peripherally inserted central catheters (PICCs) in postplacement portable chest radiographs. A retrospective analysis showed no significant difference in visualization of the PICC tip between different chest radiograph projections. Modifications were made to an institutional PICC protocol to obtain anteroposterior chest views with the guidewire present only. Repeat analysis demonstrated statistically significant increases in the frequency of anteroposterior radiographs performed, the number of chest radiographs with guidewire, and the localization of the catheter. By standardizing the acquisition of PICC placement chest radiographs, fewer variant projection radiographs were performed and the catheter tip was confidently localized in more examinations.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Melhoria de Qualidade , Radiografia Torácica , Humanos , Estudos Retrospectivos
19.
J Am Vet Med Assoc ; 251(7): 829-834, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28967817

RESUMO

OBJECTIVE To determine the anatomic location and clinical signs of thymoma in goats and long-term outcomes in a subset of goats treated by tumor excision. DESIGN Retrospective case series. ANIMALS 13 goats with a histologic diagnosis of thymoma at the Cornell University Hospital for Animals between 1990 and 2014. PROCEDURES Medical records of goats with thymoma were reviewed and data were evaluated regarding signalment, clinical signs, diagnostic imaging results, thymoma size, treatment, and outcome. Follow-up information was obtained via contact with the owners and review of medical records. RESULTS 8 goats had a mediastinal mass, 4 had a palpable ventral cervical mass, and 1 had both types of masses. Median age at the time of diagnosis was 9.5 years (range, 3 to 12 years). Goats with a mediastinal mass had respiratory distress or marked tachypnea. Six goats were treated surgically, including all 5 with a ventral cervical mass. All 5 goats with a ventral cervical mass survived with no tumor recurrence for ≥ 1 year after excision. Only 2 goats with a mediastinal mass survived to hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the prognosis for goats following excision of ventral cervical thymomas was favorable, whereas goats with mediastinal thymomas appeared more likely to have severe clinical signs and a guarded prognosis.


Assuntos
Doenças das Cabras/diagnóstico , Timoma/veterinária , Neoplasias do Timo/veterinária , Animais , Doenças das Cabras/cirurgia , Cabras , Recidiva Local de Neoplasia , Estudos Retrospectivos , Timoma/diagnóstico , Timoma/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia , Resultado do Tratamento
20.
J Radiol Prot ; 37(4): N42-N48, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28936988

RESUMO

Our purpose in this study was to compare delivered radiation exposure via computed tomography dose index volume (CTDIvol) and dose length production (DLP) measurements from computed tomography (CT) examinations performed on scanners with and without image-quality enhancing iterative reconstruction (IR) software. A retrospective analysis was conducted on randomly selected chest, abdomen, and/or pelvis CT examinations from three different scanners from 1 January 2013 to 31 December 2013. CTDIvol and DLP measurements were obtained from two CT scanners with and one CT scanner without IR software. To evaluate inter-scanner variability, we compared measurements from the same model CT scanners, one with and one without IR software. To evaluate intra-scanner variability, we compared measurements between two scanners with IR software from different manufacturers. CT scanners with IR software aided in the overall reduction in radiation exposure, measured as CTDIvol by 30% and DLP by 39% when compared to a scanner without IR. There was no significant difference in CTDlvol or DLP measurements across different manufacturers with IR software. As a result, IR software significantly decreased the radiation exposure to patients, but there were no differences in radiation measurements across CT manufacturers with IR software.


Assuntos
Exposição à Radiação/prevenção & controle , Proteção Radiológica/métodos , Interpretação de Imagem Radiográfica Assistida por Computador , Tomógrafos Computadorizados , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Software
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