Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 8 de 8
Filter
2.
Breastfeed Med ; 14(5): 290-294, 2019 06.
Article in English | MEDLINE | ID: mdl-31107104

ABSTRACT

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.


Subject(s)
Breast Diseases/diagnostic imaging , Breast Feeding , Breast/diagnostic imaging , Clinical Protocols , Lactation , Adult , Breast/pathology , Breast Diseases/pathology , Female , Guidelines as Topic , Humans , Mothers , Postnatal Care , Societies, Medical
3.
J Am Coll Radiol ; 16(7): 902-907, 2019 Jul.
Article in English | MEDLINE | ID: mdl-30679104

ABSTRACT

PURPOSE: Bundled payments have been touted as mechanisms to optimize quality and costs. A recent feasibility study evaluating bundled payments for screening mammography episodes predated widespread adoption of digital breast tomosynthesis (DBT). We explore a similar model reflecting emerging acceptance of DBT in breast cancer screening. METHODS: Using 4-year data for 59,094 screening episodes from two large facilities within a large academic health system, we utilized published methodology to calibrate Medicare national allowable reference prices for women undergoing screening mammography before and after practice-wide implementation of DBT. RESULTS: Excluding DBT, Medicare-normalized bundled prices for traditional breast imaging 364 days downstream to screening mammography are extremely similar pre- and post-DBT implementation ($182.86 in 2013; $182.68 in 2015). The addition of DBT increased a DBT-inclusive bundled price by $53.16 (an amount lower than the $56.13 Medicare allowable fee for screening DBT) but was associated with significantly reduced recall rates (13.0% versus 9.4%; P < .0001). Without or with DBT, screening episode bundled prices remained sensitive to bundle-included services and varied little by patient age, race, or insurance status. CONCLUSIONS: Prior non-DBT approaches to bundled payment models for breast cancer screening remain viable as DBT becomes the standard of care, with bundle prices varying little by patient age, race, or insurance status. Higher DBT-inclusive bundled prices, however, highlight the need to explore societal costs more broadly (eg, reduced time away from work from fewer recalls) as bundled payment models evolve.


Subject(s)
Breast Neoplasms/diagnostic imaging , Early Detection of Cancer/methods , Health Care Costs , Mammography/economics , Patient Care Bundles/economics , Adult , Ambulatory Care , Breast Neoplasms/pathology , Databases, Factual , Early Detection of Cancer/economics , Female , Hospitals, Urban , Humans , Mammography/methods , Medicare/economics , Middle Aged , Retrospective Studies , Risk Assessment , United States
4.
Am Surg ; 84(7): 1133-1137, 2018 Jul 01.
Article in English | MEDLINE | ID: mdl-30064576

ABSTRACT

Patients often receive axillary ultrasound-biopsy (AUS-B) before clinical evaluation. One positive biopsy in the absence of palpable disease rarely indicates additional nodal involvement, but it eliminates patients from being managed by the American College of Surgeons Oncology Group Z0011 trial criteria. To determine which patients may benefit from AUS-B, we analyzed whether characteristics on AUS were associated with large-volume axillary disease and, thus, the need for axillary lymph node (LN) dissection. A retrospective review identified patients who met Z0011 criteria and underwent AUS. Clinicopathologic and ultrasound characteristics were compared between patients with ≤2 versus ≥3 positive LNs. Two hundred and seven patients with cT1-2N0 tumors underwent preoperative AUS and breast-conserving surgery. On multivariate analysis, three AUS combinations were associated with ≥3 positive LNs: cortical thickness (CT) > 4 mm + loss of fatty hilum + round shape (P = 0.0218), CT > 4 mm + loss of fatty hilum (P = 0.0211), and CT > 4 mm + round shape (P = 0.0155). Preoperative axillary LN biopsy in patients with a single abnormal LN characteristic on AUS may be unnecessary because a positive finding will eliminate management according to Z0011 criteria. Cortical thickness >4 mm combined with any other abnormal characteristic was associated with ≥3 positive LNs, supporting the performance of AUS-B in this population.


Subject(s)
Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Mastectomy, Segmental , Medical Oncology , Sentinel Lymph Node Biopsy , Societies, Medical , Ultrasonography, Interventional , Adult , Aged , Aged, 80 and over , Axilla/surgery , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/diagnostic imaging , Carcinoma, Ductal, Breast/pathology , Female , Humans , Lymph Nodes/pathology , Mastectomy, Segmental/methods , Middle Aged , Neoplasm Staging , Retrospective Studies , Treatment Outcome , Ultrasonography, Interventional/methods , United States
5.
Acad Radiol ; 25(7): 883-888, 2018 07.
Article in English | MEDLINE | ID: mdl-29373212

ABSTRACT

RATIONALE AND OBJECTIVES: The present study aims to assess associations of Medicare beneficiary screening mammography rates with local mammography facility and radiologist availability. MATERIALS AND METHODS: Mammography screening rates for Medicare fee-for-service beneficiaries were obtained for US counties using the County Health Rankings data set. County-level certified mammography facility counts were obtained from the United States Food and Drug Administration. County-level mammogram-interpreting radiologist and breast imaging subspecialist counts were determined using Centers for Medicare & Medicaid Services fee-for-service claims files. Spearman correlations and multivariable linear regressions were performed using counties' facility and radiologist counts, as well as counts normalized to counties' Medicare fee-for-service beneficiary volume and land area. RESULTS: Across 3035 included counties, average screening mammography rates were 60.5% ± 8.2% (range 26%-88%). Correlations between county-level screening rates and total mammography facilities, facilities per 100,000 square mile county area, total mammography-interpreting radiologists, and mammography-interpreting radiologists per 100,000 county-level Medicare beneficiaries were all weak (r = 0.22-0.26). Correlations between county-level screening rates and mammography rates per 100,000 Medicare beneficiaries, total breast imaging subspecialist radiologists, and breast imaging subspecialist radiologists per 100,000 Medicare beneficiaries were all minimal (r = 0.06-0.16). Multivariable analyses overall demonstrated radiologist supply to have a stronger independent effect than facility supply, although effect sizes remained weak for both. CONCLUSION: Mammography facility and radiologist supply-side factors are only weakly associated with county-level Medicare beneficiary screening mammography rates, and as such, screening mammography may differ from many other health-care services. Although efforts to enhance facility and radiologist supply may be helpful, initiatives to improve screening mammography rates should focus more on demand-side factors, such as patient education and primary care physician education and access.


Subject(s)
Breast Neoplasms/diagnostic imaging , Health Facilities/supply & distribution , Health Services Accessibility/statistics & numerical data , Mammography/statistics & numerical data , Medicare/statistics & numerical data , Radiologists/supply & distribution , Aged , Early Detection of Cancer/statistics & numerical data , Female , Humans , Retrospective Studies , United States
6.
Acad Radiol ; 25(4): 461-469, 2018 04.
Article in English | MEDLINE | ID: mdl-29199056

ABSTRACT

RATIONALE AND OBJECTIVES: To assess associations between screening mammography utilization and Medicare beneficiaries' relationships with, and impressions of, their primary care physicians. MATERIALS AND METHODS: Using the Medicare Current Beneficiary Survey Access to Care Public Use File, we retrospectively studied responses from a national random cross section of Medicare beneficiaries surveyed in 2013 regarding perceptions of their primary care physicians and their screening mammography utilization. Statistical analysis accounted for subject weighting factors to estimate national screening utilization. RESULTS: Among 7492 female Medicare beneficiaries, 62.0% (95% confidence interval 59.8%-64.2%) underwent screening mammography. Utilization was higher for beneficiaries having (vs. not) a regular medical practice or clinic (63.2% vs. 34.6%) and a usual physician (63.8% vs. 50.3%). Utilization was higher for beneficiaries very satisfied (vs. very dissatisfied) with the overall quality of care they received (66.0% vs. 35.8%), their ease of getting to a doctor (67.7% vs. 43.2%), and their physician's concerns for their health (65.7% vs. 53.4%), as well as for beneficiaries strongly agreeing (vs. strongly disagreeing) that their physician is competent (66.0% vs. 54.1%), understands what is wrong (66.3% vs. 47.1%), answers all questions (67.0% vs. 46.7%), and fosters confidence (66.0% vs. 50.6%). Independent predictors of screening mammography utilization (P < .05) were satisfaction with quality of care, having a regular practice or clinic, and satisfaction with ease of getting to their physician. CONCLUSIONS: Screening mammography utilization is higher among Medicare beneficiaries with established primary physician relationships, particularly when those relationships are favorable. To optimize screening mammography utilization, breast imagers are encouraged to support initiatives to enhance high-quality primary care relationships.


Subject(s)
Mammography/statistics & numerical data , Medicare/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Physician-Patient Relations , Primary Health Care/standards , Quality of Health Care , Clinical Competence , Early Detection of Cancer/statistics & numerical data , Empathy , Female , Health Care Surveys , Health Services Accessibility , Humans , Perception , Retrospective Studies , United States
7.
AJR Am J Roentgenol ; 208(2): 267-274, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27762603

ABSTRACT

OBJECTIVE: The purpose of this article is to delineate the potential techniques for percutaneous ablation of breast cancer, discuss the advantages and disadvantages of each technique, and provide results from recent studies on these technologies. The techniques discussed are cryotherapy, laser irradiation, microwave irradiation, radiofrequency ablation, high-intensity focused ultrasound ablation, and irreversible electroporation. CONCLUSION: Although percutaneous ablation techniques have some promising potential for less-invasive treatment of breast cancer, larger multicenter trials are needed to confirm their efficacy, especially in comparison with the reference standard of lumpectomy. The use of these techniques also leads to other remaining unanswered questions, including how to manage the axilla and which patients are the best candidates for these treatments.


Subject(s)
Ablation Techniques/methods , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/surgery , Electroporation/methods , Outcome Assessment, Health Care/methods , Surgery, Computer-Assisted/methods , Evidence-Based Medicine , Female , Humans , Treatment Outcome
8.
Pediatr Pulmonol ; 45(2): 135-40, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20082339

ABSTRACT

Is there a correlation between the 6-min walk and aerobic fitness in children? We studied healthy and cystic fibrosis (CF) subjects age 8-20 years using the 6-min walk test, treadmill graded exercise stress test, and spirometry. Six-minute walk distance (6MWD) and the product of 6MWD and body weight (6MWORK) were related to aerobic capacity. Data were analyzed using Student's t-test and Pearson correlation. 13 healthy subjects [9 females, mean age 15.8 +/- 3.6 years, % predicted forced expiratory volume in one second (FEV(1)) 105 +/- 12%, 6MWD 557 +/- 73 m, peak oxygen uptake (V' O2 max) 41.4 +/- 7.2 ml/kg/min, and heart rate (HR) at V' O2 max 180 +/- 10] and 11 CF subjects (3 females, mean age 14.3 +/- 3.8 years, FEV(1) 67 +/- 25.9%, 6MWD 468 +/- 68 m, V' O2 max 27.0 +/- 8.1 ml/kg, and HR at V' O2 max 163 +/- 22] were studied. 6MWD correlates with V' O2 max in normal subjects (r = 0.59, P < 0.05) but not in CF subjects (r = 0.09, NS). 6MWORK correlates with V' O2 max in CF subjects (r = 0.65, P < 0.05) but not in normal subjects (r = 0.278, NS). We conclude that the 6MWD corresponds with aerobic fitness in normal pediatric subjects and 6MWORK corresponds with aerobic fitness in CF subjects. We speculate that 6MWORK is superior to 6MWD for assessment of aerobic fitness in children with CF.


Subject(s)
Cystic Fibrosis/physiopathology , Exercise Test/methods , Walking/physiology , Adolescent , Child , Female , Forced Expiratory Volume/physiology , Humans , Los Angeles , Male , Physical Fitness/physiology , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL
...