scholarly journals EP.TU.569Improving Confidence and Technique When Preparing Nipple Smears for Cytology

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rishikesh Gandhewar ◽  
Natasha Jiwa ◽  
Daniel Leff
Keyword(s):  
Breast Surgery ◽  
Universal Access ◽  
Nipple Discharge ◽  
Video Feedback ◽  
Fluid Volume ◽  
Educational Video ◽  
Training Video ◽  
Clinical Uncertainty ◽  
The Mean ◽  
Smear Slide

Abstract Aims To create a sustainable means of educating breast surgeons on how to prepare nipple smears for cytology when investigating nipple discharge. Methods A nation-wide questionnaire of 51 doctors conducted in 2020 identified low confidence and competency in preparing a nipple smear slide. A 3-minute training video was subsequently created and published to the Association of Breast Surgery (ABS) website for universal access. Doctors were prompted to complete a questionnaire after watching the video to assess understanding, confidence, and obtain video feedback. Results were collected and analysed using Qualtrics software. Results 31 doctors completed the survey (10% foundation doctors, 77% specialist trainees, 13% consultants). The mean±StD nipple smears prepared per year was 1.74±0.95. The percentage of doctors who felt confident in their technique increased from 44% to 100%. Ninety-seven per cent correctly identified how to store and label the sample, previously 45%. The percentage of doctors aware of where to place the sample on the slide increased from 37% to 100%. Eighty-seven per cent were aware of the optimal fluid volume in comparison to 10% previously. All respondents felt the video was valuable and 71% of respondents indicated they would also benefit from a written list of instructions. Conclusions The preparation of nipple smear slides has historically been an area of clinical uncertainty. An educational video was successfully created to educate all grades of doctors and made universally accessible through the ABS website.

Sonographic Assessment of Amniotic Fluid Volume using Single Deepest Pocket (SDP) among Igbo Women with Uncomplicated Singleton Pregnancies.

2019 ◽  
Vol 2 (1) ◽  
pp. 1-18
Author(s):  
Chijioke Okeudo ◽  
B.U. Ezem
Keyword(s):  
Amniotic Fluid ◽  
Gestational Age ◽  
Cross Sectional Study ◽  
Fluid Volume ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
South Eastern ◽  
Amniotic Fluid Volume ◽  
The Mean ◽  
Singleton Pregnancies

Background: The amniotic fluid is fundamental for proper fetal development and growth. Ultrasound visualization of the amniotic fluid permits both subjective and objective estimates of the amniotic fluid. Objective: The objective of this study was to determine the reference values of normal single deepest pocket (SDP) – upper and lower limits, mean SDP and variation of the SDP with gestational age among Igbo women of South-Eastern Nigeria extraction carrying uncomplicated singleton pregnancy. Methodology: This was a prospective cross sectional study involving 400 women carrying uncomplicated singleton pregnancies and who were sure of the date of the first day of their last menstrual period. The single deepest pocket / maximum vertical pool were determined once at presentation at the hospital.. The study was conducted from January 1st to December 31st 2015. The second author carried out all the scanning. The SDP was obtained. Results: The womens’ mean and median ages were the same at 28 years. The gestational age range of the pregnancies was 14-41 weeks. The mean SDP was 5.8cm, while the 5th and 95th percentiles were 3.3cm and 8.5cm respectively. There was no difference in the mean SDP in both term and preterm. There was irregular but continuous rise of mean SDP to a peak of 6.8cm at gestational age of 39 weeks. In conclusion, the participants had a mean SDP of 5.8cm. There was also a positive correlation between SDP and Gestational age. We therefore recommend a longitudinal study to assess perinatal outcome and abnormal amniotic fluid volume among Igbo women of South-Eastern Nigeria. Key words: Single Deepest Pocket, Uncomplicated Singleton Pregnancy, Igbo Women.

Bioassay of Chick Edema Factor—1962 Collaborative Study

1963 ◽  
Vol 46 (3) ◽  
pp. 406-412
Author(s):  
D F Flick ◽  
James Winbush ◽  
Leo Friedman
Keyword(s):  
Collaborative Study ◽  
Test Group ◽  
Negative Control Group ◽  
Negative Control ◽  
Pericardial Fluid ◽  
Fluid Volume ◽  
Control Group ◽  
Fatty Material ◽  
Edema Factor ◽  
The Mean

Abstract The lower limits of sensitivity of the method by Douglass and Flick for the bioassay of the chick edema factor were more clearly delineated by studies this year in which toxic fatty material (TFM) was fed in duplicate trials at 0.00, 0.25, 0.50, 0.75, and 1.00 g per 16 g cottonseed oil, USP. Nine laboratories collaborated in these studies. Results indicated that the following criteria to establish presence of chick edema factor is valid: "t" value exceeds + 1.3, the mean log (pericardial fluid volume X 100) of the negative control group is 1.1460 or less, and the mean log (pericardial fluid volume X 100) of the test group is 1.1461 or more.

The rumen as a water store in sheep

1964 ◽  
Vol 15 (6) ◽  
pp. 961 ◽  
Author(s):  
JF Hecker ◽  
OE Budtz-Olsen ◽  
M Ostwald
Keyword(s):  
Water Deprivation ◽  
Alimentary Tract ◽  
Rumen Fluid ◽  
Body Weight Loss ◽  
Fluid Volume ◽  
The Body ◽  
Phenol Red ◽  
The Third ◽  
The Mean ◽  
Made In

The rumen fluid volume in sheep was measured by the method of phenol red dilution. Serial determinations made in 22 sheep deprived of food and water for up to 8 days showed that the greatest decrease in rumen fluid volume occurred during the first 2–3 days, the magnitude of the decrease depending on the initial volume. After the third day, the rate of loss of rumen fluid became slower as the rumen fluid volume became depleted. Sheep deprived of food only gave similar results to those deprived of both food and water. This absorption of rumen fluid during the first 2–3 days of food and water deprivation may account for the expansion of plasma volume which has been recorded on the third day. In a group of eight sheep deprived of food and water for 4 days, the mean rumen volume loss for the period amounted to about half the body weight loss. These results support the view that in the sheep, the water balance of the body proper is kept virtually unaltered by fluid drawn from the alimentary tract during the first days of water deprivation. The animal does not become dehydrated, in the physiological sense, until this reserve is depleted. For this reason, the rumen may be regarded as a water "store" in sheep.

Breast surgery (DRAFT)

2018 ◽  
Author(s):  
Jenna Morgan ◽  
Lynda Wyld
Keyword(s):  
Screening Programme ◽  
Breast Surgery ◽  
Nipple Discharge ◽  
Breast Disease ◽  
Breast Screening Programme ◽  
Symptomatic Disease ◽  
Familial Cancers ◽  
Breast Lumps ◽  
Asymptomatic Disease ◽  
Symptomatic Breast

Breast disease is a common surgical problem. It constitutes symptomatic disease, including breast lumps, nipple discharge, and breast abscesses, as well as asymptomatic disease detected on the NHS Breast Screening Programme (BSP) and patients identified at high risk of familial cancers. It is a busy subspecialty. Referrals for symptomatic breast disease primarily arise from primary care, where they constitute approximately 3% of general practice consultations. In addition, the NHS BSP screened over 2,000,000 women in 2014, of which 4.3% were referred for assessment. The cases in this chapter cover presentations that will be commonly encountered within the breast surgery unit, including the assessment of a breast lump and the surgical management of underlying benign and malignant pathology. It also covers the assessment and management of nipple discharge, as well as lactational and non-lactational breast abscess.

scholarly journals Efficacy and safety of tolvaptan in patients with malignant ascites: a phase 2, multicenter, open-label, dose-escalation study

2020 ◽  
Author(s):  
Toshihiro Kudo ◽  
Yoshiyuki Murai ◽  
Yoshitsugu Kojima ◽  
Kenji Uehara ◽  
Taroh Satoh
Keyword(s):  
Body Weight ◽  
Ascitic Fluid ◽  
Dose Escalation ◽  
Urine Volume ◽  
Fluid Volume ◽  
Phase 2 ◽  
Efficacy And Safety ◽  
Open Label ◽  
Dose Escalation Study ◽  
The Mean

Abstract Objective This phase 2 study examined the efficacy and safety of tolvaptan, an aquaretic drug, in the treatment of ascites associated with cancer. Methods In the dose-escalation phase, oral tolvaptan was initiated at a dose of 3.75 mg/day, and the dose was increased daily to 7.5, 15 and 30 mg/day. Dose escalation was terminated once the increase from baseline in the daily urine volume reached 500 ml, at which point the patient proceeded to the maintenance phase of 5–7 days. Improvement of ascites was determined primarily by reduction in body weight and ascitic fluid volume. Results The mean change from baseline in body weight was maintained below 0 kg throughout the study. The mean change (±standard deviation) from baseline in ascitic fluid volume at the end of treatment (EOT) was 237.45 ± 868.14 ml in 33 evaluable patients. Although an increase from baseline in ascitic fluid volume at the EOT was observed in 23 of 33 patients (maximum: 1589.3 ml, minimum: 3.83 ml), a reduction in ascitic fluid volume was observed in the remaining 10 patients (maximum: −2304.3 ml, minimum: −27.5 ml). The common treatment-emergent adverse events included vomiting (5 of 43 patients, 11.6%), abdominal distension, constipation, thirst, blood osmolarity increased and renal impairment (3 of 43 patients, 7.0% each). Conclusions Tolvaptan seemed to have no definitive effect on reducing ascites; however, it might be effective in at least some cancer patients. No new safety concerns were identified at doses of 3.75–30 mg/day.

scholarly journals Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump

2015 ◽  
Vol 97 (5) ◽  
pp. 364-368 ◽  
Author(s):  
A Chaudhry ◽  
S Hallam ◽  
A Chambers ◽  
AK Sahu ◽  
S Govindarajulu ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Visual Analogue Scale ◽  
Local Anaesthetic ◽  
Analogue Scale ◽  
Breast Surgery ◽  
Infusion Pump ◽  
Intervention Group ◽  
Tissue Expander ◽  
Control Group ◽  
The Mean

Introduction Postoperative pain after breast surgery is one of the major factors contributing to delay in mobilisation and prolonged hospital stay. A retrospective analysis was performed of patients undergoing skin sparing mastectomy and insertion of a subpectoral implant. The aim was to determine whether the use of an elastomeric local anaesthetic pump improved pain control and length of stay. Methods Twenty-five consecutive patients undergoing the above procedure were sited with an elastomeric local anaesthetic infusion pump intraoperatively, in addition to standard regular and pro re nata analgesia. The control group comprised 25 patients undergoing the same procedure in the same year who received standard analgesia alone. Visual analogue scale scores were recorded for the duration of inpatient stay, as was any further analgesic requirement. Results The median age was 51 years (range: 26–75 years) in the intervention group and 50 years (range: 28–70 years) in the control group. The mean visual analogue scale score was 0.28 (standard deviation [SD]: 0.61) at 24 hours for the intervention group and 1.84 (SD: 0.37) for the control group (p<0.0001). The mean length of stay was 1.8 days (SD: 0.71 days) for the intervention group and 2.28 days (SD: 0.94 days) for the control group (p=0.15). There were no complications involving catheter placement, leakage or toxicity relating to use of the local anaesthetic. Conclusions There was significantly reduced pain with the use of the local anaesthetic infusion pump. The elastomeric pump is a step towards enhanced patient recovery after breast surgery in the case of skin sparing mastectomy and subpectoral tissue expander reconstruction.

scholarly journals Factors indicating the accuracy of fetal weight estimation in preterm newborns with normal amniotic fluid volume

2019 ◽  
pp. 1
Author(s):  
Sahin Onur Guralp ◽  
Nevin Tüten ◽  
Abdullah Tüten ◽  
Altay Gezer
Keyword(s):  
Amniotic Fluid ◽  
Fluid Volume ◽  
Fetal Weight ◽  
Percentage Error ◽  
Absolute Percentage Error ◽  
Amniotic Fluid Volume ◽  
Inaccurate Estimation ◽  
The Mean ◽  
The Absolute ◽  
Preterm Newborns

<p><strong>Objective: </strong>To determine the factors indicating the accuracy of fetal weight estimation in the last prenatal ultrasonography before delivery in preterm newborns with normal amniotic fluid volume.</p><p><strong>Study Design: </strong>371 singleton pregnancies with normal amniotic fluid volume and delivered at between 24+0 and 37+0 weeks of gestation were evaluated in a retrospective study. Maternal and fetal demographic and clinical data, ultrasonographic measurements and findings were recorded. Any possible associations between the absolute percentage errorof fetal weight estimations and the maternal and fetal data were examined.<strong></strong></p><p><strong>Results: </strong>In 135 of the 371 women (36%), the absolute percentage errorwas greater than 10%. The mean absolute percentage errorwas 8.7±7.5%. The mean absolute percentage errorswere 4.1±2.7% and 16.8±6.4% in the accurate and inaccurate estimation groups, respectively.<strong></strong></p><p>There were no significant differences in age, body mass index (BMI), gestational age (GA) at delivery, estimated fetal weight (EFW), actual weight at birth, days from the last ultrasound examination to delivery, small for gestational age (SGA) rate, placenta localization or fetal presentation between the accurate and inaccurate estimation groups. The rate of women examined during labor was significantly higher in the inaccurate estimation group compared to the accurate estimation group. </p><p>The linear regression analysis showed that BMI (p=0.006), GA at delivery (p&lt;0.001), examination during labor (p&lt;0.001), and presence of SGA (p=0.004) were significant for the prediction of the absolute percentage error.</p><p>Standardized coefficients (β) showed that examination during labor (β=0.224) was the most important factor for the prediction of the absolute percentage error, followed by GA at delivery (β=-0.198), presence of SGA (β=-0.158), and BMI (β=0.142).</p><strong>Conclusion</strong>: In 36% of our study population, the absolute percentage error was &gt;10%. Examination during labor was the most important factor for the prediction of the absolute percentage error, followed by GA at delivery, presence of SGA, and BMI.

scholarly journals The Physician Assistant/associate Medical Workforce: 2020-2035

2021 ◽  
Author(s):  
Roderick S. Hooker ◽  
Violet A. Kulo ◽  
James F Cawley ◽  
Gerald Kayingo
Keyword(s):  
Health Care Professionals ◽  
Physician Assistant ◽  
Universal Access ◽  
Supply And Demand ◽  
Physician Assistants ◽  
Critical Parameters ◽  
National Commission ◽  
Medical Workforce ◽  
Shortage Of Physicians ◽  
The Mean

Abstract Background: Physician assistant/associates (PAs) are health care professionals whose roles expand universal access to a broad range of people across many nations. In the US, there is a growing shortage of physicians. PAs and advanced practice registered nurses (APRNs) were developed to help span medical providers' supply and demand gap. A forecasting project was undertaken to predict the likely census of PAs in the medical workforce spanning 2020 to 2035. Methods: Microsimulation modeling of the American PA workforce was performed using standard stock and flow format. The number of clinically active PAs employed in 2020 formed the baseline. Graduation rates and PA program expansion were factored as critical parameters to predict annual growth; attrition estimates balanced the equation. Two models, one based on data from the Bureau of Labor Statistics (BLS) and another based on data from the National Commission on Certification of Physician Assistants (NCCPA), were analyzed to estimate future annual PA numbers. Results: As of 2020, the BLS estimated 125,280 PAs were employed in the medical workforce; the NCCPA estimate was 148,560 PA in active practice. The mean age was 40, and 76% were female. The Accreditation Review Commission accredited 277 PA education programs for the Physician Assistant (ARC-PA), and 99% had a graduating class. The mean annual graduation cohort was 45. The BLS model predicted approximately 204,243 clinically active PAs by 2035; the NCCPA-based model predicted 211,537 PAs in clinical practice. Conclusions: A physician assistant/associate predictive model based on two data sources projects the supply of PAs by 2035 between 204,000 and 212,000: a growth rate of ± 35% (3.5% model differences). If the most likely scenario is realized, the 15-year growth of the PA will help improve the gap in the supply and demand of American medical service.

scholarly journals Comparison of two smoking cessation interventions for inpatients

2018 ◽  
Vol 44 (3) ◽  
pp. 195-201 ◽  
Author(s):  
Antonio Carlos Ferreira Campos ◽  
Angela Santos Ferreira Nani ◽  
Vilma Aparecida da Silva Fonseca ◽  
Eduardo Nani Silva ◽  
Marcos César Santos de Castro ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Risk Factor ◽  
Behavioral Therapy ◽  
Randomized Study ◽  
Significant Risk ◽  
University Hospital ◽  
Smoking History ◽  
Educational Video ◽  
Significant Independent Risk Factor ◽  
The Mean

ABSTRACT Objective: This study aimed to compare the effectiveness of two cognitive behavioral therapy-based smoking cessation interventions initiated during hospitalization and to evaluate the factors related to relapse after discharge. Methods: This was a prospective randomized study involving 90 smokers hospitalized in a university hospital. We collected data related to sociodemographic characteristics, reasons for admission, smoking-related diseases, smoking history, the degree of nicotine dependence (ND), and the level of craving. Patients were divided into two treatment groups: brief intervention (BrInter, n = 45); and intensive intervention with presentation of an educational video (InInterV, n=45). To assess relapse, all patients were assessed by telephone interview in the first, third, and sixth months after discharge. Abstinence was confirmed by measurement of exhaled carbon monoxide (eCO). Results: Of the 90 patients evaluated, 55 (61.1%) were male. The mean age was 51.1 ± 12.2 years. The degree of ND was elevated in 39 (43.4%), and withdrawal symptoms were present in 53 (58.9%). The mean eCO at baseline was 4.8 ± 4.5 ppm. The eCO correlated positively with the degree of ND (r = 0.244; p = 0.02) and negatively with the number of smoke-free days (r = −0.284; p = 0.006). There were no differences between the groups in terms of the variables related to socioeconomic status, smoking history, or hospitalization. Of the 81 patients evaluated at 6 months, 33 (40.7%) remained abstinent (9 and 24 BrInter and InInterV group patients, respectively; p = 0.001), and 48 (59.3%) had relapsed (31 and 17 BrInter and InInterV group patients, respectively; p= 0.001). Moderate or intense craving was a significant independent risk factor for relapse, with a relative risk of 4.0 (95% CI: 1.5-10.7; p < 0.00001). Conclusions: The inclusion of an educational video proved effective in reducing relapse rates. Craving is a significant risk factor for relapse.

THE EFFECT OF ALDOSTERONE ON SODIUM AND POTASSIUM DISTRIBUTION IN MAN

1966 ◽  
Vol 36 (2) ◽  
pp. 103-114 ◽  
Author(s):  
J. R. COX ◽  
MARGARET M. PLATTS ◽  
MARGARET E. HORN ◽  
ROSEMARY ADAMS ◽  
H. E. MILLER
Keyword(s):  
Body Weight ◽  
Extracellular Fluid ◽  
Fluid Volume ◽  
Exchangeable Sodium ◽  
Cumulative Urinary Excretion ◽  
Plasma Electrolyte ◽  
Urinary Potassium ◽  
Before And After ◽  
Isotope Technique ◽  
The Mean

SUMMARY Total exchangeable sodium, potassium and bromide space were measured by a triple isotope technique, and antipyrine space, body weight, plasma electrolyte concentrations and urine electrolyte excretion were determined before and after intramuscular injection of 0·5 mg. aldosterone 6-hourly for 6–8 days in nine convalescent men. After the treatment with aldosterone there were mean increases in body weight of 2·5 kg., 2·5 1. in total body water, and of 3·0 1. in extracellular fluid volume; a slight decrease in intracellular fluid volume was not significant. The mean total exchangeable sodium increased by 463 m-equiv. and the mean cumulative urinary excretion of sodium decreased by 444 m-equiv. The sodium was retained in the extracellular fluid without significant change in exchangeable intracellular sodium. Mean total exchangeable potassium was reduced by 207 m-equiv. while mean cumulative urinary potassium excretion increased by 88 m-equiv. The potassium loss was entirely intracellular. The main source of error arose from isotope counting. The coefficient of variation of the sample count minus the background exceeded ±3% in 18 out of 150 samples: these results were discarded. Sixteen of the inaccurate counts were due to low concentrations of sodium or potassium in the specimens.

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