Mammography Positioning Standards in the Digital Era: Is the Status Quo Acceptable?

OBJECTIVE: The objective of our study was to evaluate positioning of full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) compared with film-screen (FS) mammography positioning standards. MATERIALS AND METHODS: A retrospective study was conducted of consecutive patients who underwent screening FFDM in 2010-2012 and DBT in 2012-2013 at an academic institution. Examinations were performed by five experienced technologists who underwent updated standardized positioning training. Positioning criteria were assessed by consensus reads among three breast radiologists and compared with FS mammography data from a 1993 study by Bassett and colleagues. RESULTS: One hundred seventy patients (n = 340 examinations) were analyzed, showing significant differences between FFDM and DBT examinations (p < 0.05) for medial or inferior skin folds (FFDM vs DBT: craniocaudal [CC] view, 16% [n = 56] vs 23% [n = 77]; mediolateral oblique [MLO] view, 35% [n = 118] vs 45% [n = 154]), inclusion of lateral glandular tissue on CC view (FFDM vs DBT, 73% [n = 247] vs 81% [n = 274]), and concave pectoralis muscle shape (FFDM vs DBT, 36% [n = 121] vs 28% [n = 95]). In comparison with Bassett et al. data, all positioning criteria for both FFDM and DBT examinations were significantly different (p < 0.05). The largest differences were found in visualization of the pectoralis muscle on CC views and the inframammary fold on MLO views, inclusion of posterior or lateral glandular tissue, and inclusion of skin folds, with DBT and FFDM more frequently exhibiting all criteria than originally reported Bassett et al. CONCLUSION: DBT and FFDM mammograms more frequently include posterior or lateral tissue, the inframammary fold on MLO views, the pectoralis muscle on CC views, and skin folds than FS mammograms. Inclusion of more breast tissue with newer technologies suggests traditional positioning standards, in conjunction with updated standardized positioning training, are still applicable at the expense of including more skin folds.

Merging silos: collaborating for information literacy.

Collaborating across disciplines can create additive teaching-learning benefits by bringing together expertise, knowledge, and training from various perspectives. However, there are challenges to effective collaboration that need to be articulated and understood by the partners to develop a useful learning product. In this project, nurse educators and health sciences librarians developed workshops for nurses practicing in community settings. Issues that surfaced reflected a division of content and presentation style along discipline lines. Bringing together expertise involved identifying basic content to present and eliminating extra details, setting the context for learners using a practice example, and alternating handoffs to cover content and practice applications. Effective collaboration requires mutual understanding of discipline-specific information "silos" and shared negotiation of teaching and learning goals.

Beyond google: finding and evaluating web-based information for community-based nursing practice.

Nurses are challenged to find and use reliable, credible information to support clinical decision-making and to meet expectations for evidence-based nursing practice. This project targeted practicing public health and school nurses, teaching them how to access and critically evaluate web-based information resources for frontline practice. Health sciences librarians partnered with nursing faculty to develop two participatory workshops to teach skills in searching for and evaluating web-based consumer and professional practice resources. The first workshop reviewed reliable, credible consumer web-resources appropriate to use with clients, using published criteria to evaluate website credibility. In the second workshop, nurses were taught how to retrieve and evaluate health-related research from professional databases to support evidence-based nursing practice. Evaluation data indicated nurses most valued knowing about the array of reliable, credible web-based health information resources, learning how to evaluate website credibility, and understanding how to find and apply professional research literature to their own practice.

E-mentoring in public health nursing practice.

Attrition in the public health nursing work force combined with a lack of faculty to teach public health prompted development of a "long-distance" learning project. Practicing associate degree nurses enrolled in an online course in population-based practice worked with experienced public health nurse "e-mentors." Student-mentor pairs worked through course assignments, shared public health nursing experiences, and problem-solved real-time public health issues. Nursing faculty served as coordinators for student learning and mentor support. Over 3 years, 38 student-mentor pairs participated in the project. Students reported they valued the expertise and guidance of their mentors. Likewise, mentors gained confidence in their practice and abilities to mentor. Issues related to distance learning and e-mentoring centered around use of technology and adequate time to communicate with one another. E-mentoring is a viable strategy to connect nurses to a learning, sharing environment while crossing the barriers of distance, agency isolation, and busy schedules.

Testing the efficacy of a scaffolded writing intervention with online degree-completion nursing students: A quasi-experimental design.

Writing should receive dedicated time in the nursing classroom for students to become competent writers, offering practical experiences for them to critically think and organize their ideas into meaningful messages. The purpose of this pre-post quasi-experimental study was to compare implementation of a scaffolded sequence of writing assignments (intervention) to typical writing assignments (comparison) in final coursework for baccalaureate nursing (BSN) completion students. Student writing self-efficacy and writing competency were measured pre and post coursework using the Post Secondary Writerly Self-Efficacy Scale, 6 + 1 Trait scale and Holistic scale. A convenience sample of 78 BSN-completion students at two Midwestern universities in the US were recruited to participate. The sample was primarily female (83%) and Caucasian (81%). There were no significant differences between the two groups on self-efficacy scores (p = 0.594). Significant group differences were noted on writing competency as assessed by the 6 + 1 Trait scale (p = 0.004) but not the Holistic scale (p = 0.024). No significant correlation between writing self-efficacy scores and writing competency were apparent (Holistic scale, p = 0.601; 6 + 1 Trait scale, p = 0.615). Writing skill-building needs attention to assure student competency. Educational interventions implemented in BSN education must be tested for efficacy and effectiveness.

Case management for patients with heart fialure: a quality improvement intervention.

At-home case management is one strategy for improving quality of care for elderly patients with heart failure. Essential components of an effective heart failure case management intervention include frequent patient contact with the case manager and vigilant at-home monitoring of symptoms with responsive modifications to the treatment plan. It is just as important that the health care system (e.g., the acute care institution) is committed to assuring administrative support, financial backing, and dedicating clinical expert resources to achieve clinical quality improvements. In this article, the design, implementation, and outcomes of an at-home heart failure case management program are described, and challenges faced in implementing and sustaining the program are outlined.

Evaluating undergraduate nursing students' self-efficacy and competence in writing: Effects of a writing intensive intervention.

While professional nurses are expected to communicate clearly, these skills are often not explicitly taught in undergraduate nursing education. In this research study, writing self-efficacy and writing competency were evaluated in 52 nontraditional undergraduate baccalaureate completion students in two distance-mediated 16-week capstone courses. The intervention group (n = 44) experienced various genres and modalities of written assignments set in the context of evidence-based nursing practice; the comparison group (n = 8) received usual writing undergraduate curriculum instruction. Self-efficacy, measured by the Post Secondary Writerly Self-Efficacy Scale, indicated significant improvements for all self-efficacy items (all p's = 0.00). Writing competency, assessed in the intervention group using a primary trait scoring rubric (6 + 1 Trait Writing Model(®) of Instruction and Assessment), found significant differences in competency improvement on five of seven items. This pilot study demonstrated writing skills can improve in nontraditional undergraduate students with guided instruction. Further investigation with larger, culturally diverse samples is indicated to validate these results.

Program evaluation of mobile dental services for children with special health care needs.

This paper summarizes an evaluation of the Elk Mobile Dental Program for children with special health care needs. Evaluation results indicated overall client satisfaction with mobile dental unit services in the absence of competent community based dental care. Evaluator recommendations included expanding the mobile dental services along with a continued effort to establish permanent community based dental care for children with special healthcare needs. Recommendations for program improvement in the areas of patient care, service coordination, and ongoing continuous quality improvement evaluation were provided to program personnel and funding organizations. Many of the improvement recommendations were initiated during the process of the program evaluation.

Marginalization and health geomatics.

Marginalized groups have been defined as groups that have been peripheralized from the center of society. Increasing nursing knowledge of marginalized groups and the dynamics of population diversity will enable nurses to better recognize shifting health patterns, plan for utilization of health services, and determine ethnic and cultural differences that exist in marginalized populations. The authors of this article review theoretical models responsible for defining the concept marginalization, describe geographical information systems as a recommended tool to evaluate marginalized groups, and provide a case study utilizing tools and maps as a means of assessing marginal situations.