Adjusting mammography--audit recommendations in a lower-incidence Taiwanese population.

RATIONALE AND OBJECTIVES: Medical auditing of screening mammography is crucial to improving the quality of breast cancer care. Audit methodology and recommendations are well documented in the ACR's Breast Imaging Reporting and Data System (BI-RADS). However, when screening a population with a lower incidence rate of breast cancer, performance recommendations should be adjusted for a better fit. MATERIALS AND METHODS: On the basis of known lower breast cancer incidence rates in Taiwan compared with the BI-RADS study populations, the authors investigated a proposed calculation method to adjust the recommendations accordingly. A medical audit of 8,249 consecutive digital mammographic screening examinations was completed. All examinations were done by a hospital-based breast imaging department in Taiwan. Imaging interpretation and medical auditing followed the BI-RADS standards. The results were then compared with those of previous studies as well as the proposed recommendations. RESULTS: Two of the BI-RADS medical auditing recommendations were adjusted for the Taiwanese population. They were the positive predictive value (PPV) of the initial screening mammographic examination (PPV1) (changed from 5%-10% to 1.7%-3.4%) and cancer detection rate (changed from 2-10 per 1,000 to 0.7-3.4 per 1,000). In the medical auditing results, there were 89 biopsies, with 22 breast malignancies detected. PPV1 was 3.1%, PPV2 was 16.2%, and PPV3 was 24.7%. The cancer detection rate was 2.7 per 1,000 screens, with minimal cancer of 50%, node negative cancer of 71.4%, and a recall rate of 8.5%. CONCLUSION: The medical auditing results of this study are consistent with the authors' proposed adjustments to the BI-RADS recommendations for the Taiwanese population. The calculation methods would be generally applicable to other countries or populations to generate their own recommendations for screening mammography.

Cellular and humoral autoreactivity in idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a morbid, refractory lung disorder with an unknown pathogenesis. To investigate potential adaptive immune mechanisms in IPF, we compared phenotypes and effector functions of peripheral CD4 T cells, autoantibody production, and proliferative responses of pulmonary hilar lymph node CD4 T cells to autologous lung extracts from afflicted patients and normals. Our results show that greater proportions of peripheral CD4 T lymphocytes in IPF subjects expressed MHC class II and CD154 (CD40L), and they more frequently elaborated TGF-beta1, IL-10, and TNF-alpha. Abnormal CD4 T cell clonal expansions were found in all IPF patients, and 82% of these subjects also had IgG autoantibodies against cellular Ags. IPF lung extracts stimulated proliferations of autologous CD4 T cells, unlike preparations from normals or those with other lung diseases, and the IPF proliferative responses were enhanced by repeated cycles of stimulation. Thus, CD4 T cells from IPF patients have characteristics typical of cell-mediated pathologic responses, including augmented effector functions, provision of facultative help for autoantibody production, oligoclonal expansions, and proliferations driven by an Ag present in diseased tissues. Recognition that an autoreactive immune process is present in IPF can productively focus efforts toward identifying the responsible Ag, and implementing more effective therapies.

Patient-centered consumer health social network websites: a pilot study of quality of user-generated health information.

The quality of user-generated health information on consumer health social networking websites has not been studied. We collected a set of postings related to Diabetes Mellitus Type I from three such sites and classified them based on accuracy, error type, and clinical significance of error. We found 48% of postings contained medical content, and 54% of these were either incomplete or contained errors. About 85% of the incomplete and erroneous messages were potentially clinically significant.

Towards consumer-friendly PHRs: patients' experience with reviewing their health records.

Consumer-friendly Personal Health Records (PHRs) have the potential of providing patients with the basis for taking an active role in their healthcare. However, few studies focused on the features that make health records comprehensible for lay audiences. This paper presents a survey of patients' experience with reviewing their health records, in order to identify barriers to optimal record use. The data are analyzed via descriptive statistical and thematic analysis. The results point to providers' notes, laboratory test results and radiology reports as the most difficult records sections for lay reviewers. Professional medical terminology, lack of explanations of complex concepts (e.g., lab test ranges) and suboptimal data ordering emerge as the most common comprehension barriers. While most patients today access their records in paper format, electronic PHRs present much more opportunities for providing comprehension support.

A novel single step percutaneous access sheath: the initial human experience.

PURPOSE: A novel 1-step percutaneous access sheath NS has been developed that allows the insertion of a dilating balloon and renal access sheath in a single step. We present the initial human experience with this sheath. MATERIALS AND METHODS: We performed a retrospective chart and database review of the initial 30 consecutive patients undergoing percutaneous nephrostolithotomy using the NS. Data collected included patient demographics, operative and recovery parameters, and complications. RESULTS: Mean patient age was 50.4 years (range 11 to 81), mean body mass index was 31.63 kg/m(2) (range 17.1 to 65) and mean preoperative stone area was 6.23 cm(2) (range 1 to 14.6). Six and 3 patients had full and partial staghorn calculi, respectively. Access was achieved via the upper pole in 16 patients, middle pole in 7 and lower pole in 7. Mean operative time was 114.8 minutes (range 61 to 237). Mean estimated blood loss was 145.5 cc (range 10 to 500) and mean postoperative hospital stay was 4.89 days (range 2 to 14). A total of 23 patients (76.7%) had no residual calculi on postoperative computerized tomography, 5 (16.7%) had residual fragments 4 mm or less and 2 (6.7%) had residual stone fragments greater than 4 mm. There were no complications related to the NS. CONCLUSIONS: The NS is safe, easy to use and has potential advantages compared to currently available renal access sheaths.

The role of nurses in installing telehealth technology in the home.

Home telehealth involves the use of video conferencing or remote monitoring equipment in patients' homes. The installation of hardware and training of patients has historically been performed by nurses, typically RNs. This article examines the experience of RNs as telehealth installers in the Informatics for Diabetes Education and Telemedicine (IDEATel) project, where RNs were responsible for the installation of the Home Telemedicine Units (HTUs) and for training patients in the use of the HTUs, blood pressure cuffs, and fingerstick glucose meters. Average installation and training time was 166 minutes (SD 51 min). Structured interviews with RN installers revealed that patient education and training accounted for roughly two thirds of the in-home time. Technology-related problems, especially those related to telecommunications, were the primary cause of installation difficulties. Thematic analysis of installer interviews identified eight major themes and confirmed the importance of both clinical and technical knowledge during the telehealth installation process.

Laparoscopic warm renal ischemia in the solitary porcine kidney model.

OBJECTIVES: To determine the effect of a laparoscopic approach on warm renal ischemia in the pig with a solitary kidney. Although the maximal safe duration for warm ischemia during open partial nephrectomy is commonly accepted to be 30 minutes, the maximal safe ischemic time during laparoscopic partial nephrectomy has not been previously determined. METHODS: Sixteen farm pigs underwent unilateral laparoscopic right nephrectomy. Two weeks later, the pigs underwent complete laparoscopic mobilization of the remaining left kidney and were randomized to complete hilar clamp times of 0, 30, 60, or 90 minutes. Serum creatinine was evaluated before right nephrectomy and at days 0, 2, 4, 7, 14, and 30 after renal ischemia during laparoscopy. All renal specimens were evaluated by an experienced nephropathologist in a blinded fashion. RESULTS: The serum creatinine remained stable at all points in the control and 30-minute ischemia groups. The serum creatinine level rose initially on days 2 and 4 in the 60-minute and 90-minute ischemia groups but returned to baseline by day 7. At harvest, no statistically significant difference was found among the groups in serum creatinine or histologic features. CONCLUSIONS: Renal ischemic times up to 90 minutes during laparoscopy were well tolerated by the solitary porcine kidney. Possible explanations for this finding include the protective effect of a solitary kidney and the potential protective effect of relative ischemic preconditioning provided by the pneumoperitoneum.

Reduction in fibrotic tissue formation in mice genetically deficient in plasminogen activator inhibitor-1.

Mice with homozygous deletion of the plasminogen activator inhibitor-1 gene (PAI-1(-/-)) are relatively protected from bleomycin-induced pulmonary fibrosis. At least part of the protective effect appears to occur during the latter stages of the pathological process when fibrotic tissue is being deposited. To investigate the effect of PAI-1 deficiency on fibrosis, we studied the accumulation of fibrotic tissue within subcutaneously implanted polyvinyl alcohol sponges. Similar to the effect of PAI-1 deficiency on bleomycin-induced pulmonary fibrosis, the accumulation of fibrotic tissue within implanted sponges occurred more slowly in PAI-1(-/-) compared to wild-type mice. Another striking difference observed in the PAI-1(-/-) mice was the rapid removal of a fibrin-rich matrix that formed within the sponges by 1 day after implantation in both wild-type and PAI-1(-/-) mice. The pattern of connective tissue invasion also differed: cells in wild-type mice infiltrated as individually penetrating cells whereas in PAI-1(-/-) mice they did so as a well-demarcated advancing front. Providing an alternative provisional matrix by impregnating sponges with a low concentration of collagen before implantation corrected the changes induced by PAI-1 deficiency. In conclusion, PAI-1 deficiency appears to affect fibrotic tissue formation in part by altering the provisional matrix that forms soon after tissue injury.

Evaluation of PCR-ELISA for determination of telomerase activity in prostate needle biopsy and prostatic fluid specimens.

The conventional TRAP assay will determine telomerase activity in tissue or other specimens. However, methodological disadvantages limit its clinical use. We evaluated a modified TRAP assay, the telomerase PCR-ELISA, as a practical clinical system for measuring its activity in conjunction with prostate cancer (PCa). We examined telomerase activity by both TRAP and PCR-ELISA assays in 48 sextant needle biopsy (SNB) specimens from dye-marked areas of the prostate glands of 7 PCa patients. Each specimen was histologically confirmed as cancerous or cancer-free by examining a paired specimen taken from the same marked area. In addition, prostatic fluid (PF) specimens were analyzed from 18 patients, 9 of whom were diagnosed with PCa while 9 were diagnosed as cancer-free but mostly with BPH. The results on individual SNB specimens matched well for the two methods. The sensitivity (91%) and specificity (69%) for the PCR-ELISA measurements were consistent with those for the conventional TRAP assay, 88% and 81%, respectively. Quantitatively, with the PCR-ELISA assay, the mean telomerase activity (24.5+/-28.4 units) per needle core with PCa cells was significantly higher than that in needle cores without PCa cells (7.2+/-2.2 unit), as it was with the conventional TRAP assay, namely 25.6+/-27.8 units and 7.3+/-1.8 units, respectively. In PF specimens from PCa patients, which had a lower mean telomerase than was found in needle cores containing PCa cells (7.1+/-1.5 units in the PCR-ELISA, 7.2+/-1.8 units in the conventional TRAP assay), statistical analysis showed good matching between the results from the two assays, overall. In conclusion, the PCR-ELISA can be considered a reliable method to determine telomerase activity as an adjunct in the diagnosis and treatment of prostate cancer.